Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | J5697 | TX |
N | 2080N0001X | Neonatal-Perinatal Doctor | J5697 | TX |
NPI | 1013977248 |
---|---|
Provider Name | Dr. Madhava Reddy Beeram |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76502-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86J289 | BLUE SHIELD (01) | TX |
F83776 | (02) | TX |