Provider Demographics
NPI:1386632073
Name:REDMON, ROBERT BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
Last Name:REDMON
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 1:633 SUNSET LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3942
Mailing Address - Country:US
Mailing Address - Phone:540-829-8484
Mailing Address - Fax:540-829-6699
Practice Address - Street 1:633 SUNSET LN
Practice Address - Street 2:SUITE B
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3942
Practice Address - Country:US
Practice Address - Phone:540-829-8484
Practice Address - Fax:540-829-6699
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74122174400000X
VA0101035447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1386632073Medicaid
FL2386428OtherAETNA HMO
FL42279OtherBLUE CROSS BLUE SHEILD
FL5758627OtherAETNA POS
FL252821500Medicaid
FL593671648OtherTAX ID
FL8267136009OtherCIGNA INS
FL252821500Medicaid
FL42279AMedicare ID - Type Unspecified
VAVV7633B444Medicare PIN
FL42279OtherBLUE CROSS BLUE SHEILD