Provider Demographics
NPI:1730187816
Name:TUMMALA, PRATAP REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:PRATAP
Middle Name:REDDY
Last Name:TUMMALA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SARA SWAMY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1779
Mailing Address - Country:US
Mailing Address - Phone:903-891-9303
Mailing Address - Fax:903-893-9604
Practice Address - Street 1:1107 SARA SWAMY DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1779
Practice Address - Country:US
Practice Address - Phone:903-891-9303
Practice Address - Fax:903-893-9604
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2713207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161230101Medicaid
TX146496802Medicaid
TX8J6030OtherBLUE CROSS PROVIDER NUMBE
TX8J6030OtherBLUE CROSS PROVIDER NUMBE
TX8A8264Medicare UPIN
TX161230101Medicaid
00389VMedicare ID - Type UnspecifiedGROUP NUMBER