Provider Demographics
NPI:1326090754
Name:REED, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
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 1:9 MAIN ST UNIT 894
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:ID
Mailing Address - Zip Code:83850-1435
Mailing Address - Country:US
Mailing Address - Phone:208-682-2707
Mailing Address - Fax:208-682-3108
Practice Address - Street 1:301 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:ID
Practice Address - Zip Code:83850-9767
Practice Address - Country:US
Practice Address - Phone:208-682-9200
Practice Address - Fax:208-682-9300
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806278400Medicaid
ID080184721OtherRAILROAD MEDICARE
ID1185830001OtherMEDICARE DMERC
ID1104208Medicare ID - Type Unspecified
ID1185830001OtherMEDICARE DMERC