Organization
JAY R PUDUPAKKAM MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY R PUDUPAKKAM MD (MD OWNER)
(469) 374-3850
Entity
Organization
Contact information
Practice address
12221 MERIT DR, SUITE 460, DALLAS, TX 75251-2202
(469) 374-3850
(469) 374-3851
Mailing address
12221 MERIT DR, SUITE 460, DALLAS, TX 75251-2202
(469) 374-3850
(469) 374-3851
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177994401
—
TX
01
—
DE8671
MEDICARE RAILROAD
TX
Enumeration date
02/26/2007
Last updated
06/13/2008
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