Provider Demographics
NPI:1629333547
Name:DONTHI REDDY, SRINIVASA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVASA REDDY
Middle Name:
Last Name:DONTHI 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 1:314 SECOR ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6343
Mailing Address - Country:US
Mailing Address - Phone:432-620-1160
Mailing Address - Fax:432-620-1156
Practice Address - Street 1:314 SECOR ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6343
Practice Address - Country:US
Practice Address - Phone:432-620-1160
Practice Address - Fax:432-620-1156
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ61792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry