Provider Demographics
NPI:1376511485
Name:DUGGIRALA, UMA D (MD)
Entity Type:Individual
Prefix:
First Name:UMA
Middle Name:D
Last Name:DUGGIRALA
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 1:1712 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5622
Mailing Address - Country:US
Mailing Address - Phone:505-863-8058
Mailing Address - Fax:
Practice Address - Street 1:516 E. NIZHONI BLVD
Practice Address - Street 2:GALLUP INDIAN MEDICAL CENTER
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13424718Medicaid
AZ895443Medicaid
F94288Medicare UPIN
AZ895443Medicaid