Provider Demographics
NPI:1922064955
Name:PREDDY, JOHN G (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:PREDDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W NOPAL ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-5210
Mailing Address - Country:US
Mailing Address - Phone:830-278-7101
Mailing Address - Fax:830-278-1465
Practice Address - Street 1:126 W NOPAL ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5210
Practice Address - Country:US
Practice Address - Phone:830-278-7101
Practice Address - Fax:866-935-9737
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0786261QR1300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063378601Medicaid
TX091813803Medicaid
TX091813801Medicaid
TX091813802Medicaid