Provider Demographics
NPI:1164461976
Name:REED, OLIVER M (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:M
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4651 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4880
Mailing Address - Country:US
Mailing Address - Phone:813-321-1786
Mailing Address - Fax:813-321-1787
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6828
Practice Address - Country:US
Practice Address - Phone:352-596-1117
Practice Address - Fax:352-596-9865
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53426207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61472Medicare UPIN
07140Medicare ID - Type Unspecified