Healthcare Provider Details

I. General information

NPI: 1316293152
Provider Name (Legal Business Name): GRANT PATRICK REDROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E NASA PKWY STE G
WEBSTER TX
77598-5317
US

IV. Provider business mailing address

512 E NASA PKWY STE G
WEBSTER TX
77598-5317
US

V. Phone/Fax

Practice location:
  • Phone: 281-957-9658
  • Fax: 713-751-1633
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR7095
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: