Provider Demographics
NPI:1083623656
Name:SRINIVAS, GUJJARAPPA (MD)
Entity type:Individual
Prefix:
First Name:GUJJARAPPA
Middle Name:
Last Name:SRINIVAS
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 1:600 S DOBSON RD
Mailing Address - Street 2:SUITE# E 42
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5678
Mailing Address - Country:US
Mailing Address - Phone:480-963-4183
Mailing Address - Fax:480-963-4184
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:SUITE# E 42
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-963-4183
Practice Address - Fax:480-963-4184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ368892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology