Provider Demographics
NPI:1194710970
Name:REDISH, GREGORY ALAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:REDISH
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 1:9330 POPPY DR
Mailing Address - Street 2:STE 405
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4621
Mailing Address - Country:US
Mailing Address - Phone:214-320-9382
Mailing Address - Fax:214-321-1137
Practice Address - Street 1:9330 POPPY DR
Practice Address - Street 2:STE 405
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4621
Practice Address - Country:US
Practice Address - Phone:214-320-9382
Practice Address - Fax:214-321-1137
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2006207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060031201OtherRAILROAD MEDICARE
TX128832604Medicaid
TX81G602OtherBCBS
TX060035084OtherRAILROAD MEDICARE
TX128832602Medicaid
TX128832605Medicaid
TX80A138OtherBCBS
TX80A138Medicare PIN
TX84J081Medicare ID - Type Unspecified
TX8A3606Medicare PIN
TX81G602OtherBCBS