Provider Demographics
NPI:1013977958
Name:PUPPALA, ANJANEYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJANEYA
Middle Name:
Last Name:PUPPALA
Suffix:
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 1:7610 STEMMONS FWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4231
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:214-630-7293
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:MEDICAL PLAZA BLDG II SUITE 304
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-238-9696
Practice Address - Fax:972-238-9753
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9923207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85Y157OtherBCBSTX
TX122772003Medicaid
TX85Y157OtherBCBSTX
TX122772003Medicaid
TXB25694Medicare UPIN