Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 23202 | SC |
NPI | 1083673776 |
---|---|
Provider Name | Brian James Redmond |
First Address | Greenville, SC 29615-4536 |
Second Address | Seneca, SC 29678-4545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F95479 | (02) | SC |