Provider Demographics
NPI:1083607022
Name:REID, JAMES GERARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GERARD
Last Name:REID
Suffix:
Gender:M
Credentials:MD
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 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-3122
Mailing Address - Fax:209-725-3128
Practice Address - Street 1:3385 G ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0964
Practice Address - Country:US
Practice Address - Phone:209-725-3122
Practice Address - Fax:209-725-3128
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-07-15
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CAA29602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A296020Medicaid
CA00A296020Medicare PIN
CA00A296021Medicare PIN
CA00A296020Medicaid