Provider Demographics
NPI:1174650584
Name:DOYTT D. REDMOND, M.D., P.A.
Entity Type:Organization
Organization Name:DOYTT D. REDMOND, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOYTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:432-464-2420
Mailing Address - Street 1:714 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3617
Mailing Address - Country:US
Mailing Address - Phone:432-464-2420
Mailing Address - Fax:432-464-2563
Practice Address - Street 1:714 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3617
Practice Address - Country:US
Practice Address - Phone:432-464-2420
Practice Address - Fax:432-464-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9585208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30581Medicare UPIN
TX00821XMedicare PIN