Provider Demographics
NPI:1356346241
Name:VALLURY, VENKATA A (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:A
Last Name:VALLURY
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 1:700 N PEARL ST STE N510
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2863
Mailing Address - Country:US
Mailing Address - Phone:214-580-7277
Mailing Address - Fax:214-999-9363
Practice Address - Street 1:13000 JOSEY LN STE 100
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-3669
Practice Address - Country:US
Practice Address - Phone:972-791-8029
Practice Address - Fax:214-999-9363
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH 7241208000000X
TXH7241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0165412Medicaid