Organization
MMC DOC MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVASA REDDY MD (OWNER)
(623) 341-6539
Entity
Organization
Contact information
Practice address
13216 N PLAZA DEL RIO BLVD, PEORIA, AZ 85381-4907
(623) 977-5003
Mailing address
7298 W AVENIDA DEL SOL, PEORIA, AZ 85383-3257
(623) 341-6539
(708) 801-7128
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
34403
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
956740
AHCCCS ID - AZ MEDICAID
AZ
Enumeration date
09/19/2012
Last updated
09/19/2012
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