Provider Demographics
NPI:1275565236
Name:REDDY, KOTA JAGDISH (MD)
Entity Type:Individual
Prefix:DR
First Name:KOTA
Middle Name:JAGDISH
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:PO BOX 2566
Mailing Address - Street 2:
Mailing Address - City:SUGARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-2566
Mailing Address - Country:US
Mailing Address - Phone:281-491-0044
Mailing Address - Fax:713-777-8617
Practice Address - Street 1:3519 TOWN CENTER BLVD S
Practice Address - Street 2:
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-491-0044
Practice Address - Fax:713-777-8617
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2568207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G48165Medicare UPIN
TX00424TMedicare ID - Type Unspecified