Provider Demographics
NPI:1366490252
Name:REDDY, RAJKUMAR P (MD)
Entity type:Individual
Prefix:DR
First Name:RAJKUMAR
Middle Name:P
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1709 RUIDOSA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6848
Mailing Address - Country:US
Mailing Address - Phone:405-359-6353
Mailing Address - Fax:
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6485
Practice Address - Country:US
Practice Address - Phone:405-579-1444
Practice Address - Fax:405-579-1448
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK179572080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine