Provider Demographics
NPI:1003336561
Name:REED, IAN (DO)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-446-5417
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:2525 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3028
Practice Address - Country:US
Practice Address - Phone:765-807-2320
Practice Address - Fax:765-807-2330
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005480A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine