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General NPI Number Information
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NPI Number | 1962438770
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Entity Type | Individual
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Provider Name | MYRON BROOK REDD MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 3001 SANFORD PKWY
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701
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Country | US
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Telephone | 218-681-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 11608 HWY 32 NE
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-2700
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Country | US
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Telephone | 218-280-7062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2009038289
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 46083
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License Number State | MN
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