MEDICARE: SREEDEVI DAGGUBATI 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	207RH0003X	Hematology & Oncology Physician	L1554	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01547644	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	852180	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952373656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SREEDEVI DAGGUBATI MD

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-234-2987

Provider Business Practice Location Address
First Line	:	4411 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3832
Country	:	US
Telephone Number	:	210-595-5300
Fax Number	:	210-614-8740

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	02/18/2016

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Directions to “ SREEDEVI DAGGUBATI MD” Practice Location

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