Provider Demographics
NPI:1134296106
Name:REDD, PHILLIP JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JAMES
Last Name:REDD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-7000
Mailing Address - Fax:208-302-7055
Practice Address - Street 1:1150 N SISTER CATHERINE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-302-7000
Practice Address - Fax:208-302-7055
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDO-0596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine