Provider Demographics
NPI:1205827698
Name:REDDY, DEVENDER DARAM (MD)
Entity Type:Individual
Prefix:
First Name:DEVENDER
Middle Name:DARAM
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 1:427 W 20TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2433
Mailing Address - Country:US
Mailing Address - Phone:713-861-8191
Mailing Address - Fax:713-861-5026
Practice Address - Street 1:427 W 20TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2433
Practice Address - Country:US
Practice Address - Phone:713-861-8191
Practice Address - Fax:713-861-5026
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2169207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110106827OtherRR MEDICARE
TX0099286901Medicaid
TX10017654OtherAMERIGROUP
TX110106827OtherRR MEDICARE
TX10017654OtherAMERIGROUP