Healthcare Provider Details

I. General information

NPI: 1225134943
Provider Name (Legal Business Name): MURTHY V. R. GEDALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MURTHY VENKATA RAMANA GEDALA MD

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DALLAS ST
SAN ANTONIO TX
78205-1201
US

IV. Provider business mailing address

PO BOX 782467 12951 HUEBNER RD
SAN ANTONIO TX
78278-2467
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-7000
  • Fax:
Mailing address:
  • Phone: 210-374-2929
  • Fax: 210-802-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM1697
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM1697
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1697
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: