Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 47908 | CO |
N | 207X00000X | Orthopaedic Surgeon | A90878 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 47908 | CO |
NPI | 1023211794 |
---|---|
Provider Name | John Carlton Redfern |
First Address | Colorado Springs, CO 80920-7835 |
Second Address | Colorado Springs, CO 80920-7835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 05/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87255065 | (05) | CO |