Provider Demographics
NPI:1558371534
Name:REDMON, JONATHAN L (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:REDMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18955 N MEMORIAL DR
Mailing Address - Street 2:SUITE 560
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4271
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 560
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4271
Practice Address - Country:US
Practice Address - Phone:832-644-1804
Practice Address - Fax:832-644-1876
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9641208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CG799OtherBCBS OF TEXAS
TX162930504Medicaid
TX8F24535Medicare PIN
TX162930504Medicaid