Basic Information
| Provider Information | |||||||||
| NPI: | 1336257237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | VEERA | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 W COLUMBIA ST | ||||||||
| Address2: | SOUTHEAST MISSOURI MENTAL HEALTH CENTER | ||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636402902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732186792 | ||||||||
| FaxNumber: | 5732186703 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 W COLUMBIA ST | ||||||||
| Address2: | SOUTHEAST MISSOURI MENTAL HEALTH CENTER | ||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636402902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732186792 | ||||||||
| FaxNumber: | 5732186703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 105498 | MO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 105498 | 01 | MO | MO PROFESSIONAL LICENSE | OTHER |