Provider Demographics
NPI:1790934321
Name:RAO, GOPALA KRISHNA BALAPPA (MD, MRCP)
Entity Type:Individual
Prefix:
First Name:GOPALA KRISHNA
Middle Name:BALAPPA
Last Name:RAO
Suffix:
Gender:M
Credentials:MD, MRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1615 PRECINCT LINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3345
Mailing Address - Country:US
Mailing Address - Phone:817-510-1060
Mailing Address - Fax:817-510-9940
Practice Address - Street 1:1305 AIRPORT FWY STE 424
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6608
Practice Address - Country:US
Practice Address - Phone:817-510-1060
Practice Address - Fax:817-510-9940
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD444491207R00000X, 208M00000X
TXR7860207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
406235802Medicaid