Active NPI
Mark William Redrow, MD
- Medical Oncology Physician
- Fort Worth, TX
National Provider Identifier
1689615726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Oncology Physician
- License
- G9383
- Practice address
- 1001 12TH Ave
Suite 200
Fort Worth, TX 76104-3926 - Phone
- (817) 850-2000
- Fax
- (817) 850-2065
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Oncology Physician | 207RX0202X | G9383 | TX | Primary |
Addresses
Primary practice location
1001 12TH Ave
Suite 200
Fort Worth, TX 76104-3926
Mailing address
PO Box 911230
Dallas, TX 75391-1230
Phone (972) 997-8000
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8R1533 | Other | TX | BLUE CROSS OF TEXAS |
| 136100803 | Medicaid | TX | |
| 136100806 | Other | TX | CSHCN |
| 136100809 | Medicaid | TX | |
| 136100807 | Medicaid | TX | |
| 136100801 | Medicaid | TX |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243468800000",
"number": "1689615726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 911230",
"city": "DALLAS",
"state": "TX",
"postal_code": "753911230",
"telephone_number": "972-997-8000",
"fax_number": "972-234-2987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 12TH AVE",
"address_2": "SUITE 200",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761043926",
"telephone_number": "817-850-2000",
"fax_number": "817-850-2065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDROW",
"first_name": "MARK",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2009-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RX0202X",
"taxonomy_group": "",
"desc": "Internal Medicine, Medical Oncology",
"state": "TX",
"license": "G9383",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF TEXAS",
"identifier": "8R1533",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136100803",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSHCN",
"identifier": "136100806",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136100809",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136100807",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136100801",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.