Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 00008168 | AL |
NPI | 1043224496 |
---|---|
Provider Name | Gaddum J.m Reddy |
First Address | Big Spring, TX 79720-6645 |
Second Address | Big Spring, TX 79720-5566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | TX |