Individual
MR. KEVIN LAMAR REDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
520 ROSE LN, WICKENBURG, AZ 85390-1447
(928) 684-5421
(289) 684-7457
Mailing address
3811 E BELL RD STE 309, PHOENIX, AZ 85032-2160
(480) 420-0749
(480) 420-0732
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
2477
AZ
363AS0400X
Surgical Physician Assistant
Primary
2477
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
577786
—
AZ
05
—
577786001
—
AZ
01
—
AZ0146700
BLUE CROSS BLUE SHIELD AZ
AZ
Enumeration date
05/27/2005
Last updated
04/26/2024
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