MEDICARE: VASANTH R NAMIREDDY MD

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	207Q00000X	Family Medicine Physician	H9125	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080193722	OTHER		RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1265457089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASANTH R NAMIREDDY MD

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-292-9230

Provider Business Practice Location Address
First Line	:	6009 WESTCREEK DRIVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3330
Country	:	US
Telephone Number	:	817-292-2550
Fax Number	:	817-292-9230

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	10/14/2011

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Directions to “ VASANTH R NAMIREDDY MD” Practice Location

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