Provider Demographics
NPI:1467596684
Name:REED, JAMES RICHARD (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:REED
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 E PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9100
Mailing Address - Country:US
Mailing Address - Phone:109-603-0116
Mailing Address - Fax:
Practice Address - Street 1:11945 E PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9100
Practice Address - Country:US
Practice Address - Phone:109-603-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ254323367500000X
NC228245367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43BBBCJMedicare ID - Type Unspecified
GAP39664Medicare UPIN