Provider Demographics
NPI:1407844889
Name:SAGIREDDY, P B (MD)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:B
Last Name:SAGIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E MARCH LN
Mailing Address - Street 2:SUITE B265
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6629
Mailing Address - Country:US
Mailing Address - Phone:209-546-1868
Mailing Address - Fax:209-461-6504
Practice Address - Street 1:1801 E MARCH LN
Practice Address - Street 2:SUITE B265
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6629
Practice Address - Country:US
Practice Address - Phone:209-546-1868
Practice Address - Fax:209-461-6504
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA73135207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A73510Medicaid
CA00A731351Medicaid
CADA0971OtherRAILROAD MEDICARE
CA00A731352Medicare ID - Type Unspecified
CA00A73510Medicaid