Provider Demographics
NPI:1437123742
Name:REED, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:REED
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5220 BELFORT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:904-446-3451
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:3903 S 7TH ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5710
Practice Address - Country:US
Practice Address - Phone:812-234-5400
Practice Address - Fax:812-234-5420
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01057163A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200424060Medicaid
IN200424060Medicaid
147180EEMedicare PIN