Provider Demographics
NPI:1811031172
Name:REDDY, JAGAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGAN
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3712 LAKE POWELL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4159
Mailing Address - Country:US
Mailing Address - Phone:817-572-5111
Mailing Address - Fax:214-331-0153
Practice Address - Street 1:1380 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4914
Practice Address - Country:US
Practice Address - Phone:214-743-1200
Practice Address - Fax:214-689-6482
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG17562084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8450Medicare ID - Type Unspecified