Provider Demographics
NPI:1326076803
Name:RADA, JOHN B III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:RADA
Suffix:III
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:DEPT 1868
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-1868
Mailing Address - Country:US
Mailing Address - Phone:901-372-4418
Mailing Address - Fax:901-383-4854
Practice Address - Street 1:6570 STAGE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-2862
Practice Address - Country:US
Practice Address - Phone:901-372-4418
Practice Address - Fax:901-383-4854
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-11-30
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Provider Licenses
StateLicense IDTaxonomies
TNMD11983207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3187069Medicare PIN
B59472Medicare UPIN