Active NPI
Mark W Redor, M.D.
- Specialist
- Placerville, CA
National Provider Identifier
1013963594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G56411
- Practice address
- 1006 Marshall Way
Placerville, CA 95667-5706 - Phone
- (530) 622-6430
- Fax
- (530) 622-3957
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | G56411 | CA | Primary |
Addresses
Primary practice location
1006 Marshall Way
Placerville, CA 95667-5706
Mailing address
1006 Marshall Way
Placerville, CA 95667-5706
Phone (530) 622-6430
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56411 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Regional Medical Foundation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Fairfield, CA
- NPI 1558388504
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243382400000",
"number": "1013963594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1006 MARSHALL WAY",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "956675706",
"telephone_number": "530-622-6430",
"fax_number": "530-622-3957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1006 MARSHALL WAY",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "956675706",
"telephone_number": "530-622-6430",
"fax_number": "530-622-3957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDOR",
"first_name": "MARK",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2009-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G56411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Placerville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.