Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 670 | NM |
NPI | 1053386888 |
---|---|
Provider Name | Vernon S. Redd |
First Address | Albuquerque, NM 87112-5401 |
Second Address | Albuquerque, NM 87112-5401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 09/07/2007 |