Provider Demographics
NPI:1295712297
Name:REDD, JOHN TERRELL (MD, MPH, FACP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TERRELL
Last Name:REDD
Suffix:
Gender:M
Credentials:MD, MPH, FACP
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Mailing Address - Street 1:1700 CERRILLOS RD
Mailing Address - Street 2:SANTA FE INDIAN HOSPITAL
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3554
Mailing Address - Country:US
Mailing Address - Phone:505-988-9821
Mailing Address - Fax:505-946-9556
Practice Address - Street 1:1700 CERRILLOS RD
Practice Address - Street 2:SANTA FE INDIAN HOSPITAL
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3554
Practice Address - Country:US
Practice Address - Phone:505-988-9821
Practice Address - Fax:505-946-9556
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY185542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR4898Medicaid
NMR4898Medicaid