Provider Demographics
NPI:1114939410
Name:TIYYAGURA S REDDY MD PA
Entity Type:Organization
Organization Name:TIYYAGURA S REDDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TIYYAGURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-863-2105
Mailing Address - Street 1:PO BOX 21767
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1767
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-823-9502
Practice Address - Street 1:7614 JACQUE RD STE B
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7195
Practice Address - Country:US
Practice Address - Phone:727-863-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty