MEDICARE: SIDNEY L REDELS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	F4416	TX
2	207Q00000X	Family Medicine Physician	F4416	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679562615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY L REDELS DO

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-606-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1761 W LOOP 281
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-2734
Country	:	US
Telephone Number	:	903-297-1733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	04/10/2024

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Directions to “ SIDNEY L REDELS DO” Practice Location

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