Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 15576 | AL |
NPI | 1013943943 |
---|---|
Provider Name | Venkatapuram Gopikrishna Reddy |
First Address | Valley, AL 36854-3611 |
Second Address | Valley, AL 36854-3611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 16/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000020196 | (05) | AL |
051594983 | BCBS OFFICE PROVIDER NUMBER (01) | AL |
051595758 | BCBS HOSPITAL PROVIDER ID (01) | AL |
20196 | (02) | AL |
263273039 | TAX ID (01) | AL |
510G700445 | MEDICARE GROUP (01) | AL |
F10952 | (02) | AL |