Provider Demographics
NPI:1588752364
Name:REDDY, AGARA S (MD)
Entity type:Individual
Prefix:
First Name:AGARA
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1705 EAST BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-875-7889
Mailing Address - Fax:573-875-0149
Practice Address - Street 1:1705 EAST BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-875-7889
Practice Address - Fax:573-875-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1K152084P0800X
MOMOR1K152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C36308Medicare UPIN