Healthcare Provider Details

I. General information

NPI: 1215121793
Provider Name (Legal Business Name): RICHARD A REDD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 BROOK HOLLOW DR
WICHITA FALLS TX
76308-2206
US

IV. Provider business mailing address

PO BOX 8337
AMARILLO TX
79114-8337
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-6593
  • Fax: 806-352-8774
Mailing address:
  • Phone: 806-355-6593
  • Fax: 806-352-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberF2870
License Number StateTX

VIII. Authorized Official

Name: DR. RICHARD ALLAN REDD
Title or Position: RADIOLOGIST
Credential: MD
Phone: 940-691-9382