MEDICARE: DR. PAUL REDMOND 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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	S2877	TX
2	208000000X	Pediatrics Physician	T-2703	MS

General Provider Information

NPI Number	:	1366882789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL REDMOND MD

Provider Business Mailing Address
First Line	:	2215 NASHVILLE AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79410-1105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 NASHVILLE AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79410-1105
Country	:	US
Telephone Number	:	806-725-4800
Fax Number	:

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

Provider Enumeration Date	:	06/29/2013
Last Update Date	:	06/15/2020

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