Provider Demographics
NPI:1134183361
Name:KURAGUNTLA, PAUL R (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:KURAGUNTLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1333 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4317
Mailing Address - Country:US
Mailing Address - Phone:304-327-2907
Mailing Address - Fax:304-327-2989
Practice Address - Street 1:1333 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4317
Practice Address - Country:US
Practice Address - Phone:304-327-2907
Practice Address - Fax:304-327-2989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV19940207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5701003000Medicaid
B67012Medicare UPIN
WV5701003000Medicaid