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General NPI Number Information
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NPI Number | 1144287947
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Entity Type | Individual
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Provider Name | VIJAYABHASKER K REDDY MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 909 ASPEN RIDGE DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-3840
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Country | US
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Telephone | 817-917-6647
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Fax | 870-338-8239
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Provider Business Mailing Address
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Address Line | 107 HICKORY HILLS DR
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City | HELENA
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State | AR
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Zip | 72342-2301
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Country | US
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Telephone | 870-338-8377
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Fax | 870-338-8239
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M5464
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E1310
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M5464
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License Number State | TX
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