Provider Demographics
NPI:1235309964
Name:DENTON OB/GYN PA
Entity type:Organization
Organization Name:DENTON OB/GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INDRANI
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-320-2745
Mailing Address - Street 1:3537 S I-35 E STE 214
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6814
Mailing Address - Country:US
Mailing Address - Phone:940-320-2745
Mailing Address - Fax:940-565-1215
Practice Address - Street 1:3537 S I-35 E STE 214
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6814
Practice Address - Country:US
Practice Address - Phone:940-320-2745
Practice Address - Fax:940-565-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00672YMedicare UPIN