Individual
JONATHAN R REDWING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
(903) 939-7728
Mailing address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
(903) 939-7728
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA07915
TX
363AS0400X
Surgical Physician Assistant
PA20070012
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM00RL61
BCBS
NM
01
—
10034669
CIGNA/LOVELACE
NM
05
—
80203361
—
NM
01
—
P00465646
RAILROAD MCEDICARE
NM
Enumeration date
03/05/2007
Last updated
10/23/2022
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