Basic Information
| Provider Information | |||||||||
| NPI: | 1265552657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALASAREDDI | ||||||||
| FirstName: | SRI LAXMI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 AFFLINK PL | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354062289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053669740 | ||||||||
| FaxNumber: | 2053449992 | ||||||||
| Practice Location | |||||||||
| Address1: | 1118 ROSS CLARK CIR STE 200 | ||||||||
| Address2: | |||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349444673 | ||||||||
| FaxNumber: | 3347123309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 32537 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 32537 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | MD.32537 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 149990 | 05 | AL | MEDICAID | 51138040 | 01 | AL | BCBS OF AL | OTHER | 51138041 | 01 | AL | BCBS OF AL | OTHER | 149486 | 05 | AL | MEDICAID |