Healthcare Provider Details

I. General information

NPI: 1265494611
Provider Name (Legal Business Name): ROBERT N. REDDIX JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S SONCY RD STE 104
AMARILLO TX
79119-6405
US

IV. Provider business mailing address

367 S GULPH RD, ATN :IPM CREDENTIALING ATN :IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 806-398-3627
  • Fax: 806-351-7801
Mailing address:
  • Phone: 806-398-3627
  • Fax: 806-351-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL7133
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2006-00209
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberL7133
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: