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NPI Code Detail

MEDICARE: SHOBHA DHARAM REDDY M.D.

MEDICARE: SHOBHA DHARAM 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
1207R00000XInternal Medicine PhysicianM3369TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235151523
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHOBHA DHARAM REDDY M.D.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3108 RANCH ROAD 620 S
Second Line :
City : LAKEWAY
State : TX
Zip : 78738-5635
Country : US
Telephone Number : 512-654-4200
Fax Number : 512-654-4201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 12/22/2021

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Directions to “ SHOBHA DHARAM REDDY M.D.” Practice Location

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