=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730187816
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRATAP REDDY TUMMALA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1107 SARA SWAMY DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-1779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-891-9303
-----------------------------------------------------
Fax | 903-893-9604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 SARA SWAMY DRIVE
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-1779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-891-9303
-----------------------------------------------------
Fax | 903-893-9604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | L2713
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------