Provider Demographics
NPI:1730185711
Name:REDDY, UDAY K (MD)
Entity type:Individual
Prefix:DR
First Name:UDAY
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2329
Mailing Address - Country:US
Mailing Address - Phone:520-476-3503
Mailing Address - Fax:928-342-6863
Practice Address - Street 1:11518 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-8994
Practice Address - Country:US
Practice Address - Phone:928-342-6500
Practice Address - Fax:928-342-6863
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55144207K00000X, 207K00000X
TXL7533207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ558198Medicaid
AZZ258608OtherMEDICARE PTAN
TX1641920-02Medicaid
TX8J2285Medicare PIN
TX8J9334Medicare PIN