Provider Demographics
NPI:1104893031
Name:REDFERN, FREDERICK CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CHARLES
Last Name:REDFERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N GREEN VALLEY PKWY STE 4B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5886
Mailing Address - Country:US
Mailing Address - Phone:702-456-2400
Mailing Address - Fax:702-456-4265
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 4B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5886
Practice Address - Country:US
Practice Address - Phone:702-456-2400
Practice Address - Fax:702-456-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5752207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0501117OtherGHI
NV002002569Medicaid
NV0421390001Medicare NSC
NV002002569Medicaid