MEDICARE: DR. ANNA TALLEY REDMAN M.D.

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	207Q00000X	Family Medicine Physician	C6658	AR

General Provider Information

NPI Number	:	1679577662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA TALLEY REDMAN M.D.

Provider Business Mailing Address
First Line	:	1801 W 40TH AVE
Second Line	:	STE 6A
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-6963
Country	:	US
Telephone Number	:	870-541-9373
Fax Number	:	870-541-0109

Provider Business Practice Location Address
First Line	:	1801 W 40TH AVE
Second Line	:	STE 6A
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-6963
Country	:	US
Telephone Number	:	870-541-9373
Fax Number	:	870-541-0109

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/20/2020

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