Individual
TIYYAGURA S REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7614 JACQUE RD STE B, HUDSON, FL 34667-7195
(727) 863-2105
(727) 862-2512
Mailing address
2410 NORTHSIDE DR, CLEARWATER, FL 33761-2236
(727) 499-0358
(727) 781-3312
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME40196
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042172300
—
FL
01
—
110012967
RAILROAD MEDICARE
—
01
—
167251
WELLCARE
FL
01
—
211156
AVMED
FL
01
—
51256
BLUE CROS BLUE SHIELD
FL
Enumeration date
08/13/2006
Last updated
01/19/2017
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