Provider Demographics
NPI:1437269206
Name:REDD, BURTON L (MD)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:L
Last Name:REDD
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:PO BOX 2632
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2632
Mailing Address - Country:US
Mailing Address - Phone:559-625-0551
Mailing Address - Fax:559-733-4475
Practice Address - Street 1:820 S AKERS
Practice Address - Street 2:220
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8309
Practice Address - Country:US
Practice Address - Phone:559-625-0551
Practice Address - Fax:559-733-4475
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21774207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41383Medicare UPIN
CA00G217740Medicare ID - Type Unspecified