Provider Demographics
NPI:1538481031
Name:JONATHAN REDMON MD PA
Entity Type:Organization
Organization Name:JONATHAN REDMON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-644-1804
Mailing Address - Street 1:18955 N MEMORIAL DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4263
Mailing Address - Country:US
Mailing Address - Phone:832-644-1804
Mailing Address - Fax:832-644-1876
Practice Address - Street 1:18955 N MEMORIAL DR
Practice Address - Street 2:SUITE 330
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4263
Practice Address - Country:US
Practice Address - Phone:832-644-1804
Practice Address - Fax:832-644-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216154902Medicaid
TX0072TEOtherBCBS OF TEXAS
TX0072TEOtherBCBS OF TEXAS