Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | H9408 | TX |
NPI | 1073579025 |
---|---|
Provider Name | Dr. Vance Allan Redfield |
First Address | Dallas, TX 75225-4819 |
Second Address | Dallas, TX 75246-2096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00J07T | (05) | TX |
E95108 | (02) | TX |