Individual
DR. SREENIVAS GUDIMETLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 RIVER NORTH BLVD, STEPHENVILLE, TX 76401-1803
(254) 968-6051
(254) 968-4950
Mailing address
150 RIVER NORTH BLVD, STEPHENVILLE, TX 76401-1803
(254) 968-6051
(254) 968-4950
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
J2041
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060057347
RAILROAD MEDICARE PROV NO
TX
05
—
125365003
—
TX
01
—
193006902
UNITED HEALTHCARE PROV NO
TX
01
—
2749061002
CIGNA PROVIDER NUMBER
TX
01
—
5673038
AETNA PROVIDER NUMBER
TX
01
—
89755J
BCBS PROVIDER NUMBER
TX
01
—
89790V
BLUE CROSS
TX
01
—
P00074958
RAIL ROAD MEDICARE
—
Enumeration date
06/20/2005
Last updated
04/08/2008
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