Provider Demographics
NPI:1831299569
Name:NELAPOLU, DURGA P (MD)
Entity type:Individual
Prefix:
First Name:DURGA
Middle Name:P
Last Name:NELAPOLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-0205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-740-8516
Practice Address - Street 1:2821 LACKLAND RD STE 216
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4193
Practice Address - Country:US
Practice Address - Phone:817-378-3640
Practice Address - Fax:817-740-8516
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2013-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN1013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201347603Medicaid