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1336145333

NPI Code Detail

MEDICARE: SRINIVASA A REDDY MD

MEDICARE: SRINIVASA A REDDY 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	207R00000X	Internal Medicine Physician	L2091	TX
2	207RC0000X	Cardiovascular Disease Physician	L2091	TX
3	207RI0011X	Interventional Cardiology Physician	L2091	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22577	OTHER	OK	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336145333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVASA A REDDY MD

Provider Business Mailing Address
First Line	:	5012 S US HIGHWAY 75 STE 300
Second Line	:	ATT.BILLING
City	:	DENISON
State	:	TX
Zip	:	75020-4589
Country	:	US
Telephone Number	:	903-465-3624
Fax Number	:	903-465-3973

Provider Business Practice Location Address
First Line	:	5026 POOL ROAD
Second Line	:
City	:	DENISON
State	:	TX
Zip	:	75020-4595
Country	:	US
Telephone Number	:	903-465-3624
Fax Number	:	903-465-3973

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	10/09/2017

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Directions to “ SRINIVASA A REDDY MD” Practice Location

Language	Start Address	Practice Location

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