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NPI Code Detail

MEDICARE: MALLADI & REDDY, PA

MEDICARE: MALLADI & REDDY, PA
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
1207RG0100XGastroenterology Physician

General Provider Information

NPI Number : 1508986373
Entity Type Code : Organization
Provider Name (Legal Business Name) : MALLADI & REDDY, PA
Provider Business Mailing Address
First Line : 319 GASLIGHT BLVD
Second Line :
City : LUFKIN
State : TX
Zip : 75904-3124
Country : US
Telephone Number : 936-634-3713
Fax Number : 936-634-8136
Provider Business Practice Location Address
First Line : 319 GASLIGHT BLVD
Second Line :
City : LUFKIN
State : TX
Zip : 75904-3124
Country : US
Telephone Number : 936-634-3713
Fax Number : 936-634-8136
Authorized Official
Title or Position : OWNER
Name : MR. BHAGVAN REDDY MALLADI
Credential : MD
Telephone Number : 936-634-3713
Provider Enumeration Date : 03/29/2007
Last Update Date : 04/21/2021

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Directions to “MALLADI & REDDY, PA ” Practice Location

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