Provider Demographics
NPI:1114918125
Name:NAREDDY, JOGI R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOGI
Middle Name:R
Last Name:NAREDDY
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 1:14100 FIVAY RD.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7194
Mailing Address - Country:US
Mailing Address - Phone:727-862-1080
Mailing Address - Fax:727-863-3093
Practice Address - Street 1:14100 FIVAY RD.
Practice Address - Street 2:SUITE 160
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7194
Practice Address - Country:US
Practice Address - Phone:727-862-1080
Practice Address - Fax:727-863-3093
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 40160207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79699Medicare ID - Type UnspecifiedJOGI R. NAREDDY
FLD58891Medicare UPIN