Provider Demographics
NPI:1144287947
Name:REDDY, VIJAYABHASKER K (MD)
Entity type:Individual
Prefix:
First Name:VIJAYABHASKER
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VIJAY
Other - Middle Name:K
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:107 HICKORY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-2301
Mailing Address - Country:US
Mailing Address - Phone:870-338-8377
Mailing Address - Fax:870-338-8239
Practice Address - Street 1:909 ASPEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3840
Practice Address - Country:US
Practice Address - Phone:817-917-6647
Practice Address - Fax:870-338-8239
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5464207Q00000X, 207P00000X
ARE1310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131920001Medicaid
AR131920001Medicaid
AR5K548Medicare ID - Type Unspecified