Provider Demographics
NPI:1518262799
Name:HENRY A REDMON, M.D., P.A.
Entity Type:Organization
Organization Name:HENRY A REDMON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ARVIL
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-264-2676
Mailing Address - Street 1:707 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3422
Mailing Address - Country:US
Mailing Address - Phone:813-264-2676
Mailing Address - Fax:813-264-4433
Practice Address - Street 1:707 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3422
Practice Address - Country:US
Practice Address - Phone:813-264-2676
Practice Address - Fax:813-264-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFS0975410208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609860378OtherNPI-INDIVIDUAL
FL30661Medicare PIN
D54078Medicare UPIN