Provider Demographics
NPI:1619979101
Name:REDDY, RAGHUVEER M (MD)
Entity Type:Individual
Prefix:
First Name:RAGHUVEER
Middle Name:M
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 1:319 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901
Mailing Address - Country:US
Mailing Address - Phone:936-634-3713
Mailing Address - Fax:936-634-8136
Practice Address - Street 1:319 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-3124
Practice Address - Country:US
Practice Address - Phone:936-634-3713
Practice Address - Fax:936-634-8136
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7316207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098561601Medicaid
TX8J3485OtherBLUE CROSS
TX00G882Medicare PIN
TXE02391Medicare UPIN