Provider Demographics
NPI:1336104017
Name:REDDY, SURAPUREDDY SEETHARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAPUREDDY
Middle Name:SEETHARAM
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 1:106 PLUMOSA CT
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-6633
Mailing Address - Country:US
Mailing Address - Phone:956-364-0700
Mailing Address - Fax:
Practice Address - Street 1:1821 S SESAME SQ
Practice Address - Street 2:SUITE:8
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9288
Practice Address - Country:US
Practice Address - Phone:956-425-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0065KZOtherBLUE CROSS&BLUE SHEILD
TX123984OtherSUPERIOR HEALTH PLAN
TX043239502Medicaid
129771101OtherVALLEY HEALTH PLANS
TXH24815Medicare UPIN