Provider Demographics
NPI:1992904627
Name:REDMOND, JEFF S (MD)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:S
Last Name:REDMOND
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 1:206 DELTA DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7562
Mailing Address - Country:US
Mailing Address - Phone:985-237-8787
Mailing Address - Fax:
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-280-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1012002085R0202X
TN00000418542085R0202X
LAMD.2028822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK548ZOtherMEDICARE PIN
AK548XOtherMEDICARE PIN
LA1057924Medicaid
MS01002054Medicaid
LA4M2286681Medicare PIN
LA1057924Medicaid
AK548XOtherMEDICARE PIN