Individual
DR. DEEPA PONNUSAMY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.,
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
P1917
TX
282N00000X
General Acute Care Hospital
P 1917
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2008
Last updated
09/29/2014
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