Provider Demographics
NPI:1093914962
Name:MOPARTY, DEEPA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:REDDY
Last Name:MOPARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 ALLIANCE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5323
Mailing Address - Country:US
Mailing Address - Phone:469-814-6631
Mailing Address - Fax:469-814-3110
Practice Address - Street 1:4700 ALLIANCE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-6631
Practice Address - Fax:469-814-3110
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10027618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2173882-01Medicaid
TXTXB112117Medicare PIN
TXP00942734Medicare PIN