Provider Demographics
NPI:1700952462
Name:REDMOND, CLYDE R II (MD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:R
Last Name:REDMOND
Suffix:II
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 1:100 MERCY WAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-556-8600
Mailing Address - Fax:417-556-8602
Practice Address - Street 1:601 W MAPLE AVE STE 403
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5374
Practice Address - Country:US
Practice Address - Phone:479-757-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0438216208G00000X
OK28924208G00000X
MO2000156468208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200410930AMedicaid
MOP01408842OtherRAIL ROAD MEDICARE
KS201106810AMedicaid
MO204958706Medicaid
MOMA2082420Medicare PIN
MOP01408842OtherRAIL ROAD MEDICARE
MO204958706Medicaid
KS201106810AMedicaid
OK200410930AMedicaid
MOMA2083128Medicare PIN