Provider Demographics
NPI:1841382306
Name:SURYA, GUNDLAPALLI SR (MD)
Entity Type:Individual
Prefix:MR
First Name:GUNDLAPALLI
Middle Name:
Last Name:SURYA
Suffix:SR
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 1:8038 WURZBACH RD
Mailing Address - Street 2:PHYSICIANS PLAZA 1 SUITE 680
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-692-0121
Mailing Address - Fax:210-692-0116
Practice Address - Street 1:8038 WURZBACH RD
Practice Address - Street 2:PHYSICIANS PLAZA 1 SUITE 680
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-692-0121
Practice Address - Fax:210-692-0116
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH37572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097-2333-01Medicaid
TX00A44UMedicare ID - Type Unspecified
TX097-2333-01Medicaid