Provider Demographics
NPI:1164488052
Name:REDMON, JAMES E JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:REDMON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:7430 JEFFERSON BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-6159
Practice Address - Country:US
Practice Address - Phone:502-966-8675
Practice Address - Fax:502-966-8836
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY18606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
061470OtherSIHO / NMA
KY64186067Medicaid
000023025EOtherHUMANA / NMA
000000366964OtherANTHEM / NMA
1199955OtherCHA / NMA
2559676OtherCIGNA / NMA
2448450000OtherPASSPORT ADVANTAGE / NMA
50007291OtherPASSPORT / NMA
KYP00248576OtherRAILROAD MEDICARE
061470OtherSIHO / NMA
50007291OtherPASSPORT / NMA