Provider Demographics
NPI:1215184726
Name:GANDRA, BABUJI REDDY (MBBS/MD)
Entity Type:Individual
Prefix:DR
First Name:BABUJI
Middle Name:REDDY
Last Name:GANDRA
Suffix:
Gender:M
Credentials:MBBS/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2995
Mailing Address - Country:US
Mailing Address - Phone:563-355-2577
Mailing Address - Fax:563-355-4015
Practice Address - Street 1:4455 E 56TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2995
Practice Address - Country:US
Practice Address - Phone:635-355-2577
Practice Address - Fax:563-355-4015
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEMC00040462084P0800X
IAMD-435402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry