Provider Demographics
NPI:1073721650
Name:REDMOND, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:REDMOND
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 1:8245 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3356
Mailing Address - Country:US
Mailing Address - Phone:210-616-0022
Mailing Address - Fax:210-616-0258
Practice Address - Street 1:8245 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3356
Practice Address - Country:US
Practice Address - Phone:210-616-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK36342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH13807Medicare UPIN
TX00514LMedicare ID - Type Unspecified