Provider Demographics
NPI:1619938958
Name:OYULA, IGNATIUS P (MD)
Entity Type:Individual
Prefix:
First Name:IGNATIUS
Middle Name:P
Last Name:OYULA
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 1:4215 TOWNE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-9000
Mailing Address - Country:US
Mailing Address - Phone:972-464-7282
Mailing Address - Fax:
Practice Address - Street 1:4215 TOWNE LAKE CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-9000
Practice Address - Country:US
Practice Address - Phone:972-464-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA139829Medicare UPIN