Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | M8852 | TX |
N | 111NI0900X | Internist | M8852 | TX |
Y | 207RX0202X | Medical Oncology | M8852 | TX |
NPI | 1114136173 |
---|---|
Provider Name | Dr. Srinivasu Moparty |
First Address | Dallas, TX 75391-1230 |
Second Address | Dallas, TX 75237-3461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 13/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194764001 | (05) | TX |
194764002 | (05) | TX |
8AQ002 | BCBS (01) | TX |