=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336103217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VAISHNAVI N. REDDY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2006
-----------------------------------------------------
Last Update Date | 12/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2520 B F TERRY BLVD
-----------------------------------------------------
City | ROSENBERG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77471-5636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-342-6006
-----------------------------------------------------
Fax | 281-239-7554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 REGIONAL MEDICAL DR
-----------------------------------------------------
City | WHARTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77488-9719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-532-1700
-----------------------------------------------------
Fax | 979-532-4584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | K6912
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------