Provider Demographics
NPI:1003911959
Name:REDINGTON, RICHARD DANA (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DANA
Last Name:REDINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:MAYPEARL
Mailing Address - State:TX
Mailing Address - Zip Code:76064-0581
Mailing Address - Country:US
Mailing Address - Phone:817-866-3603
Mailing Address - Fax:972-937-0243
Practice Address - Street 1:1410 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2232
Practice Address - Country:US
Practice Address - Phone:972-937-1210
Practice Address - Fax:972-937-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164790-03Medicaid
TXB25831Medicare UPIN
TX1164790-03Medicaid