Individual
SANTOSH BANDUGULA REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8713
Mailing address
P.O BOX 589, FORT DEFIANCE INDIAN HOSPITAL BOARD, FORT DEFIANCE, AZ 86504
(928) 729-8713
(928) 729-8734
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C1-0001770
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000166002
—
DE
Enumeration date
10/24/2006
Last updated
10/02/2014
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