Provider Demographics
NPI:1124103338
Name:DEME, SRIKANTH REDDY (M D)
Entity type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:REDDY
Last Name:DEME
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5946
Mailing Address - Country:US
Mailing Address - Phone:432-682-4307
Mailing Address - Fax:
Practice Address - Street 1:2000 W OHIO AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5946
Practice Address - Country:US
Practice Address - Phone:432-682-4307
Practice Address - Fax:432-682-4362
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2219207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147137702Medicaid
TX8754B7Medicare PIN
TX147137702Medicaid