Healthcare Provider Details

I. General information

NPI: 1225888944
Provider Name (Legal Business Name): ROHAN REREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 RICK FRANCIS ST
EL PASO TX
79905-2841
US

IV. Provider business mailing address

130 RICK FRANCIS ST
EL PASO TX
79905-2841
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-8000
  • Fax:
Mailing address:
  • Phone: 915-215-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10094775
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: