=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588970719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEVENDER D REDDY,M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2010
-----------------------------------------------------
Last Update Date | 11/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 427 W 20TH ST SUITE 700
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-861-8191
-----------------------------------------------------
Fax | 713-861-5026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 427 W 20TH ST SUITE 700
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-861-8191
-----------------------------------------------------
Fax | 713-861-5026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYCISIAN
-----------------------------------------------------
Name | DEVENDER D REDDY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-861-8191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | H2169
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------