Healthcare Provider Details

I. General information

NPI: 1508050949
Provider Name (Legal Business Name): KANAKA DURGA PALADUGU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 NE 9TH ST
SMITHVILLE TX
78957-1025
US

IV. Provider business mailing address

PO BOX 223
BASTROP TX
78602-0223
US

V. Phone/Fax

Practice location:
  • Phone: 512-237-2411
  • Fax: 512-237-4833
Mailing address:
  • Phone: 512-321-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM8232
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101242344
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: