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General NPI Number Information
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NPI Number | 1144284233
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Entity Type | Individual
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Provider Name | YASODHARA MADHAVA REDDY MD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 4102 24TH ST SUITE 507
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City | LUBBOCK
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State | TX
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Zip | 79410-1806
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Country | US
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Telephone | 806-725-7750
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Fax | 806-723-7518
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Provider Business Mailing Address
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Address Line | 3420 22ND PLACE
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City | LUBBOCK
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State | TX
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Zip | 79410
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Country | US
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Telephone | 806-725-5844
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Fax | 806-723-6532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F8639
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License Number State | TX
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