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General NPI Number Information
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NPI Number | 1316296668
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Entity Type | Individual
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Provider Name | VIJAY BHASKAR REDDY GAYAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 2708 S RIFE MEDICAL LN STE 300
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City | ROGERS
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State | AR
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Zip | 72758-1457
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Country | US
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Telephone | 479-338-3030
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Fax | 479-338-3079
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 479-338-3030
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Fax | 479-338-3079
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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 | U9254
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | E-19843
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 281594
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License Number State | NY
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