Individual
DR. SURENDER R BODHIREDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3615 19TH ST, LUBBOCK, TX 79410-1203
(806) 744-1887
(806) 744-5545
Mailing address
14275 MIDWAY RD, SUITE 400, ADDISON, TX 75001-3614
(806) 725-4271
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
K2185
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220027645
MC RR
TX
01
—
84P031
BCBS
TX
05
—
P084P0312
—
TX
Enumeration date
01/17/2006
Last updated
09/26/2017
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