Individual
DR. TARAKUMAR REDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 285-8900
Mailing address
669 AIRPORT FWY STE 301, HURST, TX 76053-3963
(817) 285-8900
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
J0644
TX
2084P0804X
Child & Adolescent Psychiatry Physician
J0644
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128288106
—
TX
01
—
750408794
TAX-ID
TX
Enumeration date
03/27/2007
Last updated
09/19/2024
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