Provider Demographics
NPI:1275784340
Name:REED, A J (MD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:J
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 1:2456 N WOODLAWN BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3968
Mailing Address - Country:US
Mailing Address - Phone:316-685-5691
Mailing Address - Fax:316-685-0736
Practice Address - Street 1:2456 N WOODLAWN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3968
Practice Address - Country:US
Practice Address - Phone:316-685-5691
Practice Address - Fax:316-685-0736
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13686208D00000X
TXE8132208D00000X
NC22962208D00000X
CO16023208D00000X
OK8476208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS002069Medicare Oscar/Certification
KSE57657Medicare UPIN