Organization
SPECIALTY ORTHOPEDIC ASSOCIATES PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PONNAVOLU D REDDY M.D. (OWNER)
(863) 676-9523
Entity
Organization
Contact information
Practice address
1204 CARLTON AVENUE, LAKE WALES, FL 33853
(863) 676-9523
(863) 678-3043
Mailing address
PO BOX 552187, TAMPA, FL 33655-0001
(863) 676-9523
(863) 678-3043
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME85679
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE2688
RAILROAD MEDICARE
—
Enumeration date
09/20/2006
Last updated
07/18/2008
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