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General NPI Number Information
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NPI Number | 1679707046
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Entity Type | Organization
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Legal Business Name | DWARAKNATH P. REDDY, M.D.
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 1900 ROYALTY DR. SUITE 205
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City | POMONA
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State | CA
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Zip | 91767-3013
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Country | US
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Telephone | 909-629-5540
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Fax |
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Provider Business Mailing Address
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Address Line | 811 E. 11TH STREET SUITE 208
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City | UPLAND
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State | CA
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Zip | 91786-4871
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Country | US
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Telephone | 909-629-5540
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DWARAKNATH P. REDDY
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Credential | M.D.
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Telephone | 909-629-5540
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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 | A34093
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License Number State | CA
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