Provider Demographics
NPI:1447402896
Name:TUMULA, PRAVEEN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:KUMAR
Last Name:TUMULA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:806-356-8687
Practice Address - Street 1:1000 S. COULTER DRIVE, SUITE 100
Practice Address - Street 2:TEXAS ONCOLOGY - AMARILLO CANCER CENTER
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-358-8654
Practice Address - Fax:806-356-8687
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
TXP0509207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01520704OtherRAILROAD MEDICARE
TX385163602Medicaid
TX385163602Medicaid
TXTXB136004Medicare PIN