Provider Demographics
NPI:1952373656
Name:DAGGUBATI, SREEDEVI (MD)
Entity type:Individual
Prefix:
First Name:SREEDEVI
Middle Name:
Last Name:DAGGUBATI
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:4411 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3832
Practice Address - Country:US
Practice Address - Phone:210-595-5300
Practice Address - Fax:210-614-8740
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1554207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX852180OtherBCBS
TX177145303Medicaid
TXP01547644OtherRAILROAD MEDICARE
TX177145301Medicaid
TX8E0565Medicare PIN
TX852180OtherBCBS
TXP01547644OtherRAILROAD MEDICARE
TXH31823Medicare UPIN