Provider Demographics
NPI:1073514584
Name:REDDY, PRABHAKARA K (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAKARA
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-627-1800
Mailing Address - Fax:501-627-1899
Practice Address - Street 1:1455 HIGDON FERRY RD
Practice Address - Street 2:STE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6419
Practice Address - Country:US
Practice Address - Phone:501-623-2731
Practice Address - Fax:501-623-1660
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR 3235207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102475001Medicaid
AR102475001Medicaid
AR54282Medicare ID - Type Unspecified