Healthcare Provider Details

I. General information

NPI: 1114136173
Provider Name (Legal Business Name): SRINIVASU MOPARTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W WHEATLAND RD
DALLAS TX
75237-3461
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 972-709-2580
  • Fax: 972-283-9387
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-437-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10025319
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM8852
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberM8852
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: