Provider Demographics
NPI:1962698506
Name:DAVID B. REDWINE, M.D.,P.C.
Entity type:Organization
Organization Name:DAVID B. REDWINE, M.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:REDWINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-382-8622
Mailing Address - Street 1:2190 NE PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6065
Mailing Address - Country:US
Mailing Address - Phone:541-382-8622
Mailing Address - Fax:
Practice Address - Street 1:2190 NE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6065
Practice Address - Country:US
Practice Address - Phone:541-382-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26659207VG0400X
OR09578207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty