Organization
DEVABRATA GANGULY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVABRATA GANGULY MD (OWNER)
(903) 427-0500
Entity
Organization
Contact information
Practice address
3144 CLARKSVILLE ST, PARIS, TX 75460-8002
(903) 784-8700
(903) 427-0503
Mailing address
3144 CLARKSVILLE ST, PARIS, TX 75460-8002
(903) 784-8700
(903) 427-0503
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
K7287
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
K7287
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044968802
—
TX
01
—
412743
MEDICARE PTAN
TX
Enumeration date
11/06/2012
Last updated
06/29/2016
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