Healthcare Provider Details

I. General information

NPI: 1093775256
Provider Name (Legal Business Name): ANURADHA S GOPALACHAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 W AMARILLO BLVD
AMARILLO TX
79106-1990
US

IV. Provider business mailing address

PO BOX 840026
DALLAS TX
75284-0026
US

V. Phone/Fax

Practice location:
  • Phone: 806-354-7871
  • Fax: 806-468-1863
Mailing address:
  • Phone: 806-212-6965
  • Fax: 806-212-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK6855
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: