Provider Demographics
NPI:1083673776
Name:REDMOND, BRIAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
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 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10630 CLEMSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4545
Practice Address - Country:US
Practice Address - Phone:864-482-6000
Practice Address - Fax:864-482-7000
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23202207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC232028Medicaid
SC200044781OtherRR MEDICARE
SCF95479Medicare UPIN