Shravan Kumar Reddy Gangula, M.D
Family Medicine in Coffeyville, KS. Individual provider (NPI-1).
NPI number1437463593
StatusActive
Last updated in NPPESDec 15, 2017
Details
- NPI
- 1437463593
- Entity type
- Individual (NPI-1)
- Name
- Shravan Kumar Reddy Gangula
- Credential
- M.D
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 31, 2010
- Last updated
- Dec 15, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 0436385 | KS | Yes |
| 207Q00000X | Family Medicine | 27717 | OK |
Practice location
1400 W 4th StCoffeyville, KS 67337-3306
Phone 620-688-6566 · Fax 620-688-6577
Mailing address
8337 E 81st St Apt 1237Tulsa, OK 74133-8088
Phone 615-415-5392
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