Provider Demographics
NPI:1275631525
Name:GANESHAPPA, KOMARANAHALLI P (MD)
Entity Type:Individual
Prefix:DR
First Name:KOMARANAHALLI
Middle Name:P
Last Name:GANESHAPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17650
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-0650
Mailing Address - Country:US
Mailing Address - Phone:210-253-3422
Mailing Address - Fax:210-227-9833
Practice Address - Street 1:621 CAMDEN STREET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1639
Practice Address - Country:US
Practice Address - Phone:210-253-3422
Practice Address - Fax:210-227-9833
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4578207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097437002Medicaid
TX100007418OtherMEDICARE - RAILROAD
TX88X770OtherBC/BS
TX100007418OtherMEDICARE - RAILROAD
TX88X770OtherBC/BS