Provider Demographics
NPI:1053515221
Name:BUGGANA, SRINIVASA REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVASA
Middle Name:REDDY
Last Name:BUGGANA
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:PO BOX 91988
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-1988
Mailing Address - Country:US
Mailing Address - Phone:863-682-0843
Mailing Address - Fax:863-687-3971
Practice Address - Street 1:135 E. FIRST STREET
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4609
Practice Address - Country:US
Practice Address - Phone:863-682-0843
Practice Address - Fax:863-687-3971
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023678800Medicaid
FL279139100Medicaid
FLAE983ZMedicare PIN