Provider Demographics
NPI:1558348649
Name:REDD, HANS THURGOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:THURGOOD
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 1:100 SHC BLDG
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83460
Mailing Address - Country:US
Mailing Address - Phone:208-496-1300
Mailing Address - Fax:208-496-1306
Practice Address - Street 1:100 SHC
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83460-2010
Practice Address - Country:US
Practice Address - Phone:208-496-1300
Practice Address - Fax:208-496-1306
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM 7079207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics