Provider Demographics
NPI:1497885347
Name:VALLOPPILLIL M.D.
Entity Type:Organization
Organization Name:VALLOPPILLIL M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:VALLOPPILLIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-245-7317
Mailing Address - Street 1:1407 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3529
Mailing Address - Country:US
Mailing Address - Phone:979-245-7317
Mailing Address - Fax:979-245-7319
Practice Address - Street 1:1407 AVENUE H
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3529
Practice Address - Country:US
Practice Address - Phone:979-245-7317
Practice Address - Fax:979-245-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5972207R00000X
TXE5971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057AUMedicare PIN