Provider Demographics
NPI:1982607586
Name:VALLABHAN, GIRISH CHIYYARATH (MD)
Entity Type:Individual
Prefix:DR
First Name:GIRISH
Middle Name:CHIYYARATH
Last Name:VALLABHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 93005
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-3005
Mailing Address - Country:US
Mailing Address - Phone:806-771-0077
Mailing Address - Fax:806-771-3175
Practice Address - Street 1:6102 82ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0802
Practice Address - Country:US
Practice Address - Phone:806-771-0077
Practice Address - Fax:806-771-3175
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6672208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046390301Medicaid
TX046390301Medicaid
TXF65563Medicare UPIN