Provider Demographics
NPI:1558394601
Name:GURRU, MANOHER L (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOHER
Middle Name:L
Last Name:GURRU
Suffix:
Gender:M
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:PO BOX 4100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4100
Mailing Address - Country:US
Mailing Address - Phone:432-570-9991
Mailing Address - Fax:432-570-9998
Practice Address - Street 1:3400 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5100
Practice Address - Country:US
Practice Address - Phone:432-570-9991
Practice Address - Fax:432-570-9998
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL29142084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL2914OtherTX LICENSE
TX149254801Medicaid
TX0018HQOtherBCBS
TX8F6600OtherBCBS
TX149254801Medicaid
TX8115B0Medicare PIN
TX8F6600OtherBCBS