Provider Demographics
NPI:1285756015
Name:PAUL C. REDMAN, II, M.D.
Entity type:Organization
Organization Name:PAUL C. REDMAN, II, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:254-754-0300
Mailing Address - Street 1:3115 PINE AVE
Mailing Address - Street 2:SUITE 708
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3247
Mailing Address - Country:US
Mailing Address - Phone:254-754-0300
Mailing Address - Fax:254-754-0301
Practice Address - Street 1:3115 PINE AVE
Practice Address - Street 2:SUITE 708
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3247
Practice Address - Country:US
Practice Address - Phone:254-754-0300
Practice Address - Fax:254-754-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094NAOtherBCBS
TXM2456OtherMEDICAL LICENSE NUMBER
TXM2456OtherMEDICAL LICENSE NUMBER
TX00W350Medicare ID - Type Unspecified