Provider Demographics
NPI:1922080613
Name:REDDICK, MAX EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:EDWARD
Last Name:REDDICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:# 247
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-465-2549
Mailing Address - Fax:713-465-2444
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:# 247
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-465-2549
Practice Address - Fax:713-465-2444
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE0589207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B25826Medicare UPIN
00P050Medicare ID - Type Unspecified