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Organization
SHANTHI G REDDY MD PA
Active
Organization
SHANTHI G REDDY MD PA
Active
Other names
DR SHANTHI G REDDY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANTHI G REDDY MD PA (PHYSICIAN)
(409) 755-3600
Entity
Organization
Contact information
Practice address
1233 S MAIN ST, LUMBERTON, TX 77657-7390
(409) 755-3600
(409) 755-4443
Mailing address
1233 S MAIN ST, LUMBERTON, TX 77657-7390
(409) 755-3600
(409) 755-4443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J3587
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A6210
MEDICARE GROUP PTAN
TX
01
—
1114244845
GROUP NPI
TX
01
—
1134127681
NPI -INDIVIDUAL
TX
01
—
8F24399
MEDICARE INDIVIDUAL PTAN
TX
01
—
J3587
TEXAS LICENSE
TX
Enumeration date
04/20/2010
Last updated
03/07/2023
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