Provider Demographics
NPI:1225134943
Name:GEDALA, MURTHY V R (MD)
Entity Type:Individual
Prefix:DR
First Name:MURTHY
Middle Name:V R
Last Name:GEDALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MURTHY
Other - Middle Name:VENKATA RAMANA
Other - Last Name:GEDALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 782467
Mailing Address - Street 2:12951 HUEBNER RD
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-2467
Mailing Address - Country:US
Mailing Address - Phone:210-374-2929
Mailing Address - Fax:210-802-2620
Practice Address - Street 1:111 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1201
Practice Address - Country:US
Practice Address - Phone:210-297-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1697208M00000X, 207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179212903Medicaid
TX179212902Medicaid
TX179212902Medicaid
TX179212903Medicaid
TXTXB104966Medicare PIN