Provider Demographics
NPI:1821087438
Name:GARNEPUDI, MARY J (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:GARNEPUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 OGLETREE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9444
Mailing Address - Country:US
Mailing Address - Phone:936-327-7799
Mailing Address - Fax:
Practice Address - Street 1:403 OGLETREE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9444
Practice Address - Country:US
Practice Address - Phone:936-327-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8650207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10050921OtherAMERIGROUP
TX48587742OtherCIGNA
TX1116871OtherAETNA
TX21140705603OtherBEECH STREET
TX111454804Medicaid
TX111454806Medicaid
TX8H8816OtherBCBS
TX8H8816OtherBCBS
TX8G1589Medicare PIN
TX111454804Medicaid