MEDICARE: DR. VIMAL A REDDY DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3091	FL

General Provider Information

NPI Number	:	1962470617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIMAL A REDDY DPM

Provider Business Mailing Address
First Line	:	8075 GATE PKWY W
Second Line	:	SUITE 301
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3684
Country	:	US
Telephone Number	:	904-739-9129
Fax Number	:	904-739-9127

Provider Business Practice Location Address
First Line	:	8075 GATE PKWY W
Second Line	:	SUITE 301
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3684
Country	:	US
Telephone Number	:	904-739-9129
Fax Number	:	904-739-9127

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	04/08/2015

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Directions to “ DR. VIMAL A REDDY DPM” Practice Location

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