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General NPI Number Information
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NPI Number | 1215184726
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Entity Type | Individual
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Provider Name | BABUJI REDDY GANDRA MBBS/MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 4455 E 56TH ST
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City | DAVENPORT
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State | IA
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Zip | 52807-2995
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Country | US
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Telephone | 635-355-2577
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Fax | 563-355-4015
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Provider Business Mailing Address
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Address Line | 4455 E 56TH ST
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City | DAVENPORT
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State | IA
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Zip | 52807-2995
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Country | US
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Telephone | 563-355-2577
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Fax | 563-355-4015
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | EMC0004046
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-43540
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License Number State | IA
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