Healthcare Provider Details

I. General information

NPI: 1174936892
Provider Name (Legal Business Name): PRIYANKA REDDY GUDOOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

6161 S YALE AVE
TULSA OK
74136-1902
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-5977
  • Fax: 817-433-5989
Mailing address:
  • Phone: 918-502-1900
  • Fax: 918-494-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number32852
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV4915
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: