Provider Demographics
NPI:1992969760
Name:JOHN G PREDDY DO
Entity type:Organization
Organization Name:JOHN G PREDDY DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-278-7101
Mailing Address - Street 1:126 W NOPAL
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-5210
Mailing Address - Country:US
Mailing Address - Phone:830-278-7101
Mailing Address - Fax:866-935-9737
Practice Address - Street 1:126 W NOPAL
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5210
Practice Address - Country:US
Practice Address - Phone:830-278-7101
Practice Address - Fax:866-935-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0786261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063378601Medicaid
TXF30574Medicare UPIN
TX453818Medicare Oscar/Certification