Provider Demographics
NPI:1073588059
Name:PARAGON PRIMARY CARE PHYSICIANS, PA
Entity Type:Organization
Organization Name:PARAGON PRIMARY CARE PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PALLAVOLU
Authorized Official - Middle Name:N
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-579-3000
Mailing Address - Street 1:20911 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5548
Mailing Address - Country:US
Mailing Address - Phone:281-579-3000
Mailing Address - Fax:281-579-3001
Practice Address - Street 1:20911 KINGSLAND BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5548
Practice Address - Country:US
Practice Address - Phone:281-579-3000
Practice Address - Fax:281-579-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10031462OtherAMERIGROUP
TX096659002Medicaid
TX00477MMedicare ID - Type Unspecified
TX096659002Medicaid