Individual
GAUTHAM S GADIRAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 ROSALIND REDFERN GROVER PKWY, MIDLAND, TX 79701-5846
(432) 221-1111
Mailing address
4214 ANDREWS HWY STE 240, MIDLAND, TX 79703-4817
(432) 686-6605
(432) 682-2284
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301089687
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000701603
ANTHEM
IN
05
—
387144401
—
TX
01
—
685085
TX MEDICARE
TX
Enumeration date
08/10/2007
Last updated
09/04/2020
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