Provider Demographics
NPI:1336145333
Name:REDDY, SRINIVASA A (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASA
Middle Name:A
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SRINIVAS
Other - Middle Name:REDDY
Other - Last Name:ALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATT.BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-465-3624
Mailing Address - Fax:903-465-3973
Practice Address - Street 1:5026 POOL ROAD
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4595
Practice Address - Country:US
Practice Address - Phone:903-465-3624
Practice Address - Fax:903-465-3973
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2091207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK22577OtherMEDICAL LICENSE
TX181383403Medicaid
OK200032000AMedicaid
TX181383403Medicaid
TXH23672Medicare UPIN
OK385964ZLU2Medicare PIN