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General NPI Number Information
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NPI Number | 1225077274
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Entity Type | Individual
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Provider Name | DEVABRATA GANGULY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 1210 W MAIN ST
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City | CLARKSVILLE
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State | TX
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Zip | 75426-3523
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Country | US
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Telephone | 903-427-0500
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Fax | 903-427-0503
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Provider Business Mailing Address
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Address Line | 3144 CLARKSVILLE ST
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City | PARIS
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State | TX
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Zip | 75460-8002
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Country | US
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Telephone | 903-784-8700
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Fax | 903-784-7502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K7287
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | K7287
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License Number State | TX
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