Provider Demographics
NPI:1871609941
Name:REDD, RICHARD ALLAN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLAN
Last Name:REDD
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 1:2319 BROOK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2206
Mailing Address - Country:US
Mailing Address - Phone:940-691-9382
Mailing Address - Fax:940-691-9383
Practice Address - Street 1:2319 BROOK HOLLOW DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2206
Practice Address - Country:US
Practice Address - Phone:940-691-9382
Practice Address - Fax:940-691-9383
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF28702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00282477OtherRAILROAD MEDICARE
C20919Medicare UPIN
TXW058/8F2153Medicare ID - Type Unspecified