Provider Demographics
NPI:1134123938
Name:REDDY, SRIDHAR PATLOLLA (MD)
Entity type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:PATLOLLA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2911 MEDICAL ARTS ST
Mailing Address - Street 2:STE 9
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3302
Mailing Address - Country:US
Mailing Address - Phone:512-474-6321
Mailing Address - Fax:512-474-6324
Practice Address - Street 1:2911 MEDICAL ARTS ST
Practice Address - Street 2:STE 9
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3302
Practice Address - Country:US
Practice Address - Phone:512-474-6321
Practice Address - Fax:512-474-6324
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7639207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138857114Medicaid
TX138857115Medicaid
TX0032QSOtherBLUE CROSS BLUE SHIELD
TXF05530Medicare UPIN