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General NPI Number Information
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NPI Number | 1508986373
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Entity Type | Organization
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Legal Business Name | MALLADI & REDDY, PA
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 319 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3124
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Country | US
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Telephone | 936-634-3713
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Fax | 936-634-8136
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Provider Business Mailing Address
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Address Line | 319 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3124
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Country | US
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Telephone | 936-634-3713
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Fax | 936-634-8136
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Authorized Official
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Title or Position | OWNER
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Name | MR. BHAGVAN REDDY MALLADI
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Credential | MD
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Telephone | 936-634-3713
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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 |
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License Number State |
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