Provider Demographics
NPI:1073535076
Name:GUNUGANTI, VIJAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:K
Last Name:GUNUGANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:18707 HARDY OAK BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4791
Practice Address - Country:US
Practice Address - Phone:210-545-6972
Practice Address - Fax:210-545-1016
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1427207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174969902Medicaid
TX1121552OtherAETNA HMO
TX8S2181OtherBLUECROSS/BLUESHIELD TX.
TX174969901Medicaid
TX7326655OtherAETNA PPO
TXP00250234OtherRAILROAD MEDICARE
TXP01547608OtherRAILROAD MEDICARE
TX174969901Medicaid
TXP00250234OtherRAILROAD MEDICARE
TXI15374Medicare UPIN