Provider Demographics
NPI:1982689477
Name:GORREPATI, JAYASHREE N (MD)
Entity type:Individual
Prefix:MRS
First Name:JAYASHREE
Middle Name:N
Last Name:GORREPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4041 W WHEATLAND RD
Mailing Address - Street 2:156 343
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4064
Mailing Address - Country:US
Mailing Address - Phone:972-223-7878
Mailing Address - Fax:972-283-0284
Practice Address - Street 1:4041 W WHEATLAND RD
Practice Address - Street 2:156 343
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4064
Practice Address - Country:US
Practice Address - Phone:972-223-7878
Practice Address - Fax:972-283-0284
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9593207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046055203Medicaid
TX8B9257Medicare ID - Type Unspecified
TXF26288Medicare UPIN