Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | E5310 | TX |
N | 208G00000X | Cardiothoracic Vascular Surgeon | E5310 | TX |
NPI | 1043374507 |
---|---|
Provider Name | Janardhana P Reddy |
First Address | Mineral Wells, TX 76067-5300 |
Second Address | Mineral Wells, TX 76067-5300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 06/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
097884301 | (05) | TX |
C20931 | (02) |