MEDICARE: DR. PRABA NARAYANA REDDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	M0235	TX

General Provider Information

NPI Number	:	1063474096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRABA NARAYANA REDDY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3562
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-9562
Country	:	US
Telephone Number	:	972-393-5868
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 E PRESIDENT GEORGE BUSH HWY
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-4266
Country	:	US
Telephone Number	:	972-393-5868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/22/2009

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