MEDICARE: SRIDHAR PATLOLLA 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	207RG0100X	Gastroenterology Physician	J7639	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0032QS	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134123938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRIDHAR PATLOLLA REDDY M.D.

Provider Business Mailing Address
First Line	:	2911 MEDICAL ARTS ST
Second Line	:	STE 9
City	:	AUSTIN
State	:	TX
Zip	:	78705-3302
Country	:	US
Telephone Number	:	512-474-6321
Fax Number	:	512-474-6324

Provider Business Practice Location Address
First Line	:	2911 MEDICAL ARTS ST
Second Line	:	STE 9
City	:	AUSTIN
State	:	TX
Zip	:	78705-3302
Country	:	US
Telephone Number	:	512-474-6321
Fax Number	:	512-474-6324

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/10/2023

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