Provider Demographics
NPI:1760642334
Name:REDDEN, LAWRENCE (DOM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:REDDEN
Suffix:
Gender:M
Credentials:DOM
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 6141
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87197-6141
Mailing Address - Country:US
Mailing Address - Phone:505-315-6153
Mailing Address - Fax:
Practice Address - Street 1:6501 EAGLE ROCK AVE NE
Practice Address - Street 2:BLDG A-6
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2479
Practice Address - Country:US
Practice Address - Phone:505-315-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM801171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist