Basic Information
| Provider Information | |||||||||
| NPI: | 1700316247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAVINDER G REDDY DPM PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3136 HORIZON RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750327808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724631253 | ||||||||
| FaxNumber: | 9724631185 | ||||||||
| Practice Location | |||||||||
| Address1: | 3136 HORIZON RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | ROCKWALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750327808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724631253 | ||||||||
| FaxNumber: | 9724631185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2017 | ||||||||
| LastUpdateDate: | 06/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | REDDY | ||||||||
| AuthorizedOfficialFirstName: | RAVINDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4097673330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.