Individual
SUSAN T REDWINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 N BRYANT AVE, EDMOND, OK 73034-6273
(405) 330-7000
Mailing address
200 N BRYANT AVE, EDMOND, OK 73034-6273
(406) 330-7000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
22619
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200066430A
—
OK
01
—
22619
LICENSE
OK
01
—
30634
OBNDD
OK
Enumeration date
02/17/2006
Last updated
08/04/2010
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