Provider Demographics
NPI:1205820362
Name:REED, JEFFREY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:REED
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 1:456 N NEW BALLAS RD
Mailing Address - Street 2:STE 118
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-567-1400
Mailing Address - Fax:314-567-9559
Practice Address - Street 1:456 N NEW BALLAS RD
Practice Address - Street 2:STE 118
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6831
Practice Address - Country:US
Practice Address - Phone:314-567-1400
Practice Address - Fax:314-567-9559
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112298207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO328788OtherHEALTH LINK
MO106158OtherBLUE CROSS
MO106158OtherBLUE CROSS
MO000095549Medicare ID - Type Unspecified