Provider Demographics
NPI:1265494611
Name:REDDIX, ROBERT N JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:REDDIX
Suffix:JR
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 1:367 S GULPH RD, ATN :IPM CREDENTIALING
Mailing Address - Street 2:ATN :IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:806-398-3627
Mailing Address - Fax:806-351-7801
Practice Address - Street 1:3501 S SONCY RD STE 104
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-398-3627
Practice Address - Fax:806-351-7801
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7133207P00000X, 207X00000X
NC2006-00209207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163848806Medicaid
TX8U1283OtherBCBS
TX1U8019OtherPTAN
TXP01447545OtherRAILROAD MEDICARE
OK200993410AMedicaid
NM42056560Medicaid
TXP01666362OtherRAILROAD MEDICARE