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General NPI Number Information
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NPI Number | 1205848595
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Entity Type | Individual
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Provider Name | TIYYAGURA S REDDY
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 7614 JACQUE RD STE B
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City | HUDSON
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State | FL
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Zip | 34667-7195
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Country | US
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Telephone | 727-863-2105
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Fax | 727-862-2512
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Provider Business Mailing Address
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Address Line | 2410 NORTHSIDE DR
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City | CLEARWATER
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State | FL
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Zip | 33761-2236
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Country | US
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Telephone | 727-499-0358
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Fax | 727-781-3312
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME40196
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License Number State | FL
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