Provider Demographics
NPI:1841236106
Name:GULLAPALLI, KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:GULLAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GULLAPALLI
Other - Middle Name:K
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3901 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2622
Mailing Address - Country:US
Mailing Address - Phone:361-573-0713
Mailing Address - Fax:361-575-2215
Practice Address - Street 1:3901 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2622
Practice Address - Country:US
Practice Address - Phone:361-573-0713
Practice Address - Fax:361-575-2215
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2868207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
891491OtherBCBS
03002885OtherMDCRRR
751730541OtherTX ID
TX1060790-01Medicaid
751730541OtherTX ID
03002885OtherMDCRRR