Individual
JAY PUDUPAKKAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12221 MERIT DR STE 460, DALLAS, TX 75251-2245
(469) 374-3850
(469) 374-3851
Mailing address
12221 MERIT DR STE 460, DALLAS, TX 75251-2245
(469) 374-3850
(469) 374-3851
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
K4199
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141171205
—
TX
Enumeration date
08/04/2006
Last updated
04/22/2008
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