Provider Demographics
NPI:1902826977
Name:REDDY, JAYAPRAKASH N (MD)
Entity Type:Individual
Prefix:
First Name:JAYAPRAKASH
Middle Name:N
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:713 W BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9130
Mailing Address - Country:US
Mailing Address - Phone:972-552-3330
Mailing Address - Fax:972-552-3303
Practice Address - Street 1:713 W BROAD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9130
Practice Address - Country:US
Practice Address - Phone:972-552-3330
Practice Address - Fax:972-552-3303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20925Medicare UPIN
TX82T629Medicare PIN
TXTXB117922Medicare PIN