Healthcare Provider Details

I. General information

NPI: 1093914962
Provider Name (Legal Business Name): DEEPA REDDY MOPARTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 ALLIANCE BLVD STE 400
PLANO TX
75093-5323
US

IV. Provider business mailing address

4700 ALLIANCE BLVD STE 400
PLANO TX
75093-5323
US

V. Phone/Fax

Practice location:
  • Phone: 469-814-6631
  • Fax: 469-814-3110
Mailing address:
  • Phone: 469-814-6631
  • Fax: 469-814-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10027618
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: