Provider Demographics
NPI:1407816986
Name:REDDY, AKAVARAM N (MD)
Entity type:Individual
Prefix:DR
First Name:AKAVARAM
Middle Name:N
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 1:8216 HUNTERS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7205
Mailing Address - Country:US
Mailing Address - Phone:208-421-2347
Mailing Address - Fax:
Practice Address - Street 1:1308 8TH ST STE 1
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1535
Practice Address - Country:US
Practice Address - Phone:208-436-4322
Practice Address - Fax:208-436-1312
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD27896207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP00809352OtherMCRR
ID807465000Medicaid
ID807465000Medicaid
IDC03572Medicare UPIN