Provider Demographics
NPI:1326070277
Name:REED, JARVIS D (MD)
Entity Type:Individual
Prefix:
First Name:JARVIS
Middle Name:D
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 1:100 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2146
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-685-9718
Practice Address - Street 1:1588 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3729
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-685-9718
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19070207RH0003X
MS16924207RH0003X
ARE3186207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123758Medicaid
TN3800445Medicaid
TN41474080OOtherAHS
AR145288001Medicaid
AR5M185OtherBCBS AR
5000220OtherAETNA
TN4075428OtherBCBS TN
AR5M185OtherBCBS AR
TN4075428OtherBCBS TN
TN3800445Medicaid
TNP00178454Medicare PIN
MS830000067Medicare PIN