Provider Demographics
NPI:1679577662
Name:REDMAN, ANNA TALLEY (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:TALLEY
Last Name:REDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 W 40TH AVE
Mailing Address - Street 2:STE 6A
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6963
Mailing Address - Country:US
Mailing Address - Phone:870-541-9373
Mailing Address - Fax:870-541-0109
Practice Address - Street 1:1801 W 40TH AVE
Practice Address - Street 2:STE 6A
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6963
Practice Address - Country:US
Practice Address - Phone:870-541-9373
Practice Address - Fax:870-541-0109
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR54373Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ARB90904Medicare UPIN