Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | ME76862 | FL |
NPI | 1376540187 |
---|---|
Provider Name | Dr. Prathima Reddy |
First Address | Delray Beach, FL 33484-8194 |
Second Address | Gainesville, FL 32605-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255169100 | (05) | FL |
G80326 | (02) | FL |