Provider Demographics
NPI:1285719021
Name:REDMON, JAMES BRUCE (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRUCE
Last Name:REDMON
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-8690
Mailing Address - Fax:
Practice Address - Street 1:PWB SIXTH FLOOR, CLINIC 6A
Practice Address - Street 2:516 DELAWARE STREET SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32422207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22T39REOtherBLUE CROSS BLUE SHIELD
MN1009286OtherPREFERRED ONE
MN33-00009OtherMEDICA PRIMARY
MN33-07273OtherMEDICA CHOICE
MN314502600Medicaid
MT0051629Medicaid
MN101507OtherUCARE
MN768317OtherARAZ
MNHP22060OtherHEALTH PARTNERS
F25440Medicare UPIN
460000124Medicare ID - Type Unspecified