Provider Demographics
NPI:1902947807
Name:REDMON, ERIC MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
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 1:11408 KINGSTON PIKE STE 400
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3976
Mailing Address - Country:US
Mailing Address - Phone:865-392-1888
Mailing Address - Fax:865-392-1889
Practice Address - Street 1:11408 KINGSTON PIKE STE 400
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3976
Practice Address - Country:US
Practice Address - Phone:865-392-1888
Practice Address - Fax:865-392-1889
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000034629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003580Medicaid
TN4052923OtherBCBS OF TN
TN3859254Medicaid
TNQ003580Medicaid
TN3859254Medicaid
TN103I089347Medicare PIN
TN3859254Medicare ID - Type UnspecifiedMEDICARE