Healthcare Provider Details

I. General information

NPI: 1508846668
Provider Name (Legal Business Name): ANUJ V PEDDADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 E 48TH ST
TULSA OK
74146-5824
US

IV. Provider business mailing address

1425 N UNION BLVD SUITE 202
COLORADO SPRINGS CO
80909-2871
US

V. Phone/Fax

Practice location:
  • Phone: 918-556-3000
  • Fax:
Mailing address:
  • Phone: 719-570-7675
  • Fax: 719-471-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number47270
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number38130
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD23123
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: