Individual
DR. JAGADISH PUPPALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1643 LANCASTER DR, SUITE 203, GRAPEVINE, TX 76051-3593
(817) 329-7670
(817) 416-0145
Mailing address
1320 GREENWAY DRIVE, SUITE 200, IRVING, TX 75038-2416
(972) 550-9195
(972) 550-0079
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
K8819
TX
207UN0901X
Nuclear Cardiology Physician
K8819
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00FM06
MEDICARE GROUP NUMBER
TX
01
—
00J30H
MEDICARE GROUP NUMBER
TX
Enumeration date
08/12/2005
Last updated
01/28/2008
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