=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700061819
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SRIDHAR REDDY ALLAM M.D., M.P.H.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 E DOVE AVE STE 200
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-4681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-362-8030
-----------------------------------------------------
Fax | 956-362-8035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 749
-----------------------------------------------------
City | PHARR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78577-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-362-8030
-----------------------------------------------------
Fax | 956-362-8035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | N8480
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 204F00000X
-----------------------------------------------------
Taxonomy Name | Transplant Surgery Physician
-----------------------------------------------------
License Number | N8480
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------