Provider Demographics
NPI:1467411157
Name:REED, FREDERICK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
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 3RD STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9731
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:100 3RD STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9731
Practice Address - Country:US
Practice Address - Phone:509-725-7501
Practice Address - Fax:509-725-7504
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7556207Q00000X
WAMD00048996207Q00000X
SC29516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACJ6525OtherMEDICARE RAILROAD
WA7101132Medicaid
WA7117450Medicaid
WA508530Medicare Oscar/Certification
WA508529Medicare Oscar/Certification
WAG8869692Medicare PIN
WA7117450Medicaid
WAGAB16799Medicare PIN