1154355287 NPI number — DR. FRED MICHAEL REID M.D.

Table of content: DR. FRED MICHAEL REID M.D. (NPI 1154355287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154355287 NPI number — DR. FRED MICHAEL REID M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REID
Provider First Name:
FRED
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154355287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 CAMILLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71301-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-448-8548
Provider Business Mailing Address Fax Number:
318-448-8548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 CAMILLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-448-8548
Provider Business Practice Location Address Fax Number:
318-448-8548
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  012225 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 07848 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1344257 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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