Provider Demographics
NPI:1407839442
Name:REID, JUDITH ELLEN (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELLEN
Last Name:REID
Suffix:
Gender:F
Credentials:MD MPH
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:JAMES H. QUILLEN VA MEDICAL CENTER
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3476
Practice Address - Street 1:JAMES H. QUILLEN VA MEDICAL CENTER
Practice Address - Street 2:CORNER OF LAMONT & VETERANS WAY
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3476
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D73379Medicare UPIN
110007870Medicare ID - Type Unspecified