Provider Demographics
NPI:1700895026
Name:KALRA, GURJEET S (MD)
Entity type:Individual
Prefix:DR
First Name:GURJEET
Middle Name:S
Last Name:KALRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8354
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-8354
Mailing Address - Country:US
Mailing Address - Phone:903-454-1600
Mailing Address - Fax:903-454-2262
Practice Address - Street 1:4818 WELLINGTON ST STE 4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6010
Practice Address - Country:US
Practice Address - Phone:903-454-1600
Practice Address - Fax:903-454-2262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH48362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1367534-06Medicaid
TX00J09YMedicare ID - Type Unspecified
TX1367534-06Medicaid