Provider Demographics
NPI:1285626572
Name:MOTGI, GURUBASAPPA V (MD)
Entity Type:Individual
Prefix:DR
First Name:GURUBASAPPA
Middle Name:V
Last Name:MOTGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 ROBBIE MINCE WAY STE C
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2012
Mailing Address - Country:US
Mailing Address - Phone:214-943-3681
Mailing Address - Fax:214-941-9490
Practice Address - Street 1:1001 ROBBIE MINCE WAY
Practice Address - Street 2:STE C
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:214-943-3681
Practice Address - Fax:214-941-9490
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ17382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047145002Medicaid
TXE79208Medicare UPIN
TX047145002Medicaid
TXP00466487Medicare PIN