Provider Demographics
NPI:1093782062
Name:REID, DUSTIN LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEON
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 W 38TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1163
Mailing Address - Country:US
Mailing Address - Phone:512-371-8817
Mailing Address - Fax:512-371-8819
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1163
Practice Address - Country:US
Practice Address - Phone:512-371-8817
Practice Address - Fax:512-371-8819
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1314208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI34763Medicare UPIN
TX8F0612Medicare ID - Type Unspecified