Individual
DR. MARK WILLIAM REDROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 12TH AVE, SUITE 200, FORT WORTH, TX 76104-3926
(817) 850-2000
(817) 850-2065
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
G9383
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136100801
—
TX
05
—
136100803
—
TX
01
—
136100806
CSHCN
TX
05
—
136100807
—
TX
05
—
136100809
—
TX
01
—
8R1533
BLUE CROSS OF TEXAS
TX
Enumeration date
06/09/2006
Last updated
05/28/2009
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