Provider Demographics
NPI:1083660633
Name:GANGAPURAM REDDY, UDAYABHASKER (MD)
Entity Type:Individual
Prefix:DR
First Name:UDAYABHASKER
Middle Name:
Last Name:GANGAPURAM 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 1:5184 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-5608
Mailing Address - Country:US
Mailing Address - Phone:727-939-4748
Mailing Address - Fax:
Practice Address - Street 1:4807 US HIGHWAY 19
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4263
Practice Address - Country:US
Practice Address - Phone:727-847-9505
Practice Address - Fax:727-847-9509
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268742900Medicaid
FL51655OtherBLUE SHIELD NUMBER
FL51655OtherBLUE SHIELD NUMBER
FL51655YMedicare ID - Type Unspecified