Provider Demographics
NPI:1942270400
Name:GOGU, SUDHIR R (DO, PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:R
Last Name:GOGU
Suffix:
Gender:M
Credentials:DO, PHD, MBA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:104 GALLERY CIRCLE
Mailing Address - Street 2:STE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3330
Mailing Address - Country:US
Mailing Address - Phone:210-481-6060
Mailing Address - Fax:210-481-6068
Practice Address - Street 1:104 GALLERY CIRCLE
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3330
Practice Address - Country:US
Practice Address - Phone:210-481-6060
Practice Address - Fax:210-481-6068
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0209207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7088Medicare PIN