Individual
DR. SUNITHA GUDAPATI PUDHOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
309 REGENCY PKWY STE 101, MANSFIELD, TX 76063-5165
(682) 400-2153
(972) 572-2228
Mailing address
309 REGENCY PKWY STE 101, MANSFIELD, TX 76063-5165
(682) 400-2153
(972) 572-2228
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME94091
FL
207RG0100X
Gastroenterology Physician
MD203357
LA
207RG0100X
Gastroenterology Physician
Primary
P1484
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288404101
—
TX
01
—
8DC048
BLUE CROSS AND BLUE SHIELD OF TEXAS
TX
Enumeration date
03/29/2006
Last updated
05/29/2019
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