Provider Demographics
NPI:1689615726
Name:REDROW, MARK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:REDROW
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1001 12TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3926
Practice Address - Country:US
Practice Address - Phone:817-850-2000
Practice Address - Fax:817-850-2065
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9383207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1533OtherBLUE CROSS OF TEXAS
TX136100803Medicaid
TX136100806OtherCSHCN
TX136100809Medicaid
TX136100807Medicaid
TX136100801Medicaid
TX8R1533OtherBLUE CROSS OF TEXAS
TX136100803Medicaid
TX136100801Medicaid
TX136100807Medicaid
TX89W085Medicare PIN
TX87729KMedicare PIN