Provider Demographics
NPI:1215023791
Name:CULTON, REID ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:ERIC
Last Name:CULTON
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 1:2440 EAST WINROW AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-1106
Mailing Address - Country:US
Mailing Address - Phone:520-533-2627
Mailing Address - Fax:548-845-0116
Practice Address - Street 1:2865 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1106
Practice Address - Country:US
Practice Address - Phone:541-274-8690
Practice Address - Fax:541-884-1540
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO173012207Q00000X
TXK2674207Q00000X
AZ3760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130934607Medicaid
TX00766FMedicare ID - Type Unspecified
TX130934607Medicaid