Provider Demographics
NPI:1649250960
Name:REDDY, JAGADESHWAR G (MD)
Entity type:Individual
Prefix:DR
First Name:JAGADESHWAR
Middle Name:G
Last Name: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:PO BOX 733382
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3382
Mailing Address - Country:US
Mailing Address - Phone:214-884-4700
Mailing Address - Fax:214-884-4761
Practice Address - Street 1:1222 N BISHOP AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4176
Practice Address - Country:US
Practice Address - Phone:972-388-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3233207RC0200X, 207RP1001X
IN01067092A207RP1001X
MN47261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307949301Medicaid
TX307949301Medicaid