MEDICARE: PERRY WILLIAM REDING DDS, MD

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	G5520MD	TX
2	207Q00000X	Family Medicine Physician	G5520	TX
3	207P00000X	Emergency Medicine Physician	95-130	NM
4	207P00000X	Emergency Medicine Physician	MD00048129	WA

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
2	G5520MD	OTHER	TX	MEDICAL LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720087422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRY WILLIAM REDING DDS, MD

Provider Business Mailing Address
First Line	:	1917 NE 7TH CIR
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-9815
Country	:	US
Telephone Number	:	360-210-5748
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 NE 7TH CIR
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-9815
Country	:	US
Telephone Number	:	360-210-5748
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	12/06/2011

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Directions to “ PERRY WILLIAM REDING DDS, MD” Practice Location

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