Provider Demographics
NPI:1790776466
Name:JAMPANA, SREEMAN N (MD)
Entity Type:Individual
Prefix:
First Name:SREEMAN
Middle Name:N
Last Name:JAMPANA
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 1:1603 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3649
Mailing Address - Country:US
Mailing Address - Phone:903-758-4491
Mailing Address - Fax:903-758-0993
Practice Address - Street 1:1603 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3649
Practice Address - Country:US
Practice Address - Phone:903-758-4491
Practice Address - Fax:903-758-0993
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
752073536OtherCOMMERCIAL INSURANCES
TX123336301Medicaid
TX00HW82OtherBLUE CROSS
TX00HW82Medicare ID - Type Unspecified
752073536OtherCOMMERCIAL INSURANCES
TX123336301Medicaid