MEDICARE: GADDUM DUEMANI REDDY M.D., PH.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	207T00000X	Neurological Surgery Physician	BP10034726	TX

General Provider Information

NPI Number	:	1578894267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GADDUM DUEMANI REDDY M.D., PH.D.

Provider Business Mailing Address
First Line	:	5024 BREEZEWIND LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-6009
Country	:	US
Telephone Number	:	713-392-7289
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 W MAYFIELD RD STE 407
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2085
Country	:	US
Telephone Number	:	713-392-7289
Fax Number	:

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

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	12/02/2021

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