Healthcare Provider Details

I. General information

NPI: 1891984043
Provider Name (Legal Business Name): KOTA JAGDISH REDDY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 TOWN CENTER BLVD SUITE A
SUGAR LAND TX
77479-1001
US

IV. Provider business mailing address

P.O.BOX 2566
SUGAR LAND TX
77487-2566
US

V. Phone/Fax

Practice location:
  • Phone: 281-491-0044
  • Fax: 281-491-1447
Mailing address:
  • Phone: 281-491-0044
  • Fax: 281-491-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK2568
License Number StateTX

VIII. Authorized Official

Name: KOTA J REDDY
Title or Position: PRESIDENT
Credential: MD
Phone: 281-491-0044