Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 49844 | MN |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME117442 | FL |
NPI | 1407977606 |
---|---|
Provider Name | John M Redmond |
First Address | Jacksonville, FL 32216-8070 |
Second Address | Jacksonville, FL 32204-4712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 07/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013011100 | (05) | FL |
14X3J | BCBS FL (01) | FL |
382498000 | (05) | MN |