Provider Demographics
NPI:1013096106
Name:REDDICK, STEPHANIE A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:REDDICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13737 NOEL RD. STE. 1600- RAYS
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240
Mailing Address - Country:US
Mailing Address - Phone:303-933-8270
Mailing Address - Fax:214-712-2002
Practice Address - Street 1:5911 N CAMINO PRECIADO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4252
Practice Address - Country:US
Practice Address - Phone:303-933-8270
Practice Address - Fax:214-712-2002
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361518622085R0202X
MO20210057762085R0202X
AZ321992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00435435OtherRAILROAD MEDICARE
AZ949117Medicaid
P00435435OtherRAILROAD MEDICARE
I34878Medicare UPIN