Provider Demographics
NPI:1770635146
Name:CHALLAPALLI, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:CHALLAPALLI
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 1:500 ADAMS AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-333-2934
Mailing Address - Fax:432-333-3719
Practice Address - Street 1:500 ADAMS AVE
Practice Address - Street 2:STE 400
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-333-2934
Practice Address - Fax:432-333-3719
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032195201Medicaid
TX032195201Medicaid
C14335Medicare UPIN