Individual
DR. DEEPA BANGALORE GOTUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6565 FANNIN ST, F270, HOUSTON, TX 77030-2703
(713) 441-3020
Mailing address
6565 FANNIN ST, F270, HOUSTON, TX 77030-2703
(713) 441-3020
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
242789
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
N0628
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201387201
—
TX
05
—
201387202
—
TX
05
—
201387203
—
TX
01
—
8BQ747
BLUE CROSS BLUE SHIELD
TX
01
—
8EE524
BLUE CROSS BLUE SHIELD
TX
01
—
P01123925
RR MEDICARE
TX
01
—
P01402887
RR MEDICARE
TX
Enumeration date
06/09/2008
Last updated
09/01/2015
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