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General NPI Number Information
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NPI Number | 1598806937
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Entity Type | Organization
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Legal Business Name | OBSTETRICS AND GYNECOLOGY ASSOCIATES OF FORT WAYNE PC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 7802 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4138
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Country | US
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Telephone | 260-459-2113
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Fax | 260-459-6625
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Provider Business Mailing Address
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Address Line | 7802 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4138
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Country | US
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Telephone | 260-459-2113
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Fax | 260-459-6625
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JYOTHIRMAI K REDDY
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Credential | M.D.
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Telephone | 260-459-2113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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