Provider Demographics
NPI:1043374507
Name:REDDY, JANARDHANA P (MD , FACS)
Entity type:Individual
Prefix:
First Name:JANARDHANA
Middle Name:P
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD , FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 SE 1ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-5300
Mailing Address - Country:US
Mailing Address - Phone:940-325-1155
Mailing Address - Fax:940-328-1692
Practice Address - Street 1:400 SE 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5300
Practice Address - Country:US
Practice Address - Phone:940-325-1155
Practice Address - Fax:940-328-1692
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE53102086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097884301Medicaid
TX00D61SMedicare PIN
TX097884301Medicaid