Provider Demographics
NPI:1275638942
Name:REDDY, JAIPAL MEDINI (MD)
Entity type:Individual
Prefix:DR
First Name:JAIPAL
Middle Name:MEDINI
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:450 E YOSEMITE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8429
Mailing Address - Country:US
Mailing Address - Phone:209-383-3152
Mailing Address - Fax:209-383-3137
Practice Address - Street 1:450 E YOSEMITE AVE
Practice Address - Street 2:STE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8429
Practice Address - Country:US
Practice Address - Phone:209-383-3152
Practice Address - Fax:209-383-3137
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA62448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A624480Medicaid
CA00A624480Medicaid
CA00A624481Medicare PIN