Provider Demographics
NPI:1831209055
Name:REREDDY, JYOTHI REDDY (MD)
Entity type:Individual
Prefix:MRS
First Name:JYOTHI
Middle Name:REDDY
Last Name:REREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 W ARAPAHO RD STE 14
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5041
Mailing Address - Country:US
Mailing Address - Phone:214-346-9999
Mailing Address - Fax:214-346-9100
Practice Address - Street 1:819 W ARAPAHO RD STE 14
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5041
Practice Address - Country:US
Practice Address - Phone:214-346-9999
Practice Address - Fax:214-346-9100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018MHOtherBCBS
TX144559504Medicaid
TX144559504Medicaid
TX651233860OtherEIN
TXG90584Medicare UPIN