Provider Demographics
NPI:1881770220
Name:GUNNALA, UMA GOWRI (MD)
Entity type:Individual
Prefix:
First Name:UMA
Middle Name:GOWRI
Last Name:GUNNALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20045 N 19TH AVE BLDG 11
Mailing Address - Street 2:SUITE 165
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4252
Mailing Address - Country:US
Mailing Address - Phone:602-572-6791
Mailing Address - Fax:623-572-7099
Practice Address - Street 1:20045 N 19TH AVE BLDG 11
Practice Address - Street 2:SUITE 165
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4252
Practice Address - Country:US
Practice Address - Phone:623-572-6791
Practice Address - Fax:623-572-7099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ403379Medicaid
G53807Medicare UPIN
AZ403379Medicaid