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Individual
JOHN MARK REDWINE SR.
Active
Individual
JOHN MARK REDWINE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13521
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060041439
RR MEDICARE
SC
05
—
135213
—
SC
01
—
GP6882
MEDICAID GROUP
SC
Enumeration date
04/27/2006
Last updated
06/10/2021
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