Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2021020696 | MO |
NPI | 1013581800 |
---|---|
Provider Name | Prati Jahnu Reddy |
First Address | Phoenix, AZ 85050-5444 |
Second Address | Columbia, MO 65212-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2021 |
Last Update Date | 29/06/2021 |