Provider Demographics
NPI:1275544330
Name:SEHAPAYAK, SOMMAI (MD)
Entity Type:Individual
Prefix:
First Name:SOMMAI
Middle Name:
Last Name:SEHAPAYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4422
Mailing Address - Country:US
Mailing Address - Phone:817-338-4501
Mailing Address - Fax:817-338-4503
Practice Address - Street 1:1050 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4422
Practice Address - Country:US
Practice Address - Phone:817-338-4501
Practice Address - Fax:817-338-4503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1124208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R361Medicare PIN
TXB26340Medicare UPIN