MEDICARE: DR. GUDURU RAMANA 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	207RC0000X	Cardiovascular Disease Physician	G2824	TX
2	207RI0011X	Interventional Cardiology Physician	G2824	TX

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
2	8A0420	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1659489730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUDURU RAMANA REDDY MD

Provider Business Mailing Address
First Line	:	2614 E BANKHEAD HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-9558
Country	:	US
Telephone Number	:	817-341-8646
Fax Number	:	817-341-7270

Provider Business Practice Location Address
First Line	:	2614 E BANKHEAD HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-9558
Country	:	US
Telephone Number	:	817-341-8646
Fax Number	:	817-341-7270

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	09/15/2023

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