Provider Demographics
NPI:1194709113
Name:REDMAN, DANNY (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:REDMAN
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:PO BOX 552205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33655-0001
Mailing Address - Country:US
Mailing Address - Phone:800-476-8646
Mailing Address - Fax:919-382-3210
Practice Address - Street 1:250 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8625
Practice Address - Country:US
Practice Address - Phone:800-476-8646
Practice Address - Fax:919-382-3210
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91747207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03358OtherMELBOURNE LOCAT 34457
FL03358OtherBCBS
FL272384100Medicaid
FL03358OtherBCBS
FL03358BMedicare ID - Type UnspecifiedMELBOURNE LOCATION 34457
FLH04819Medicare UPIN
FL03358CMedicare ID - Type Unspecified45368 ROCKLEDGE LOCATION
FL272384100Medicaid