Provider Demographics
NPI:1477675254
Name:DUSTIN L. REID, MD PA
Entity Type:Organization
Organization Name:DUSTIN L. REID, MD PA
Other - Org Name:RESTORA AUSTIN PLASTIC SURGERY CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-371-8817
Mailing Address - Street 1:901 W. 38TH ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1162
Mailing Address - Country:US
Mailing Address - Phone:512-371-8817
Mailing Address - Fax:512-371-8819
Practice Address - Street 1:901 W. 38TH ST.,
Practice Address - Street 2:SUITE 401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1162
Practice Address - Country:US
Practice Address - Phone:512-371-8817
Practice Address - Fax:512-371-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1314208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093782062OtherINDIVIDUAL NPI DR. DUSTIN
TX176043101Medicaid
TX1124048343OtherNPI DR. ASHLEY GORDON
TXI34763Medicare UPIN
TX1124048343OtherNPI DR. ASHLEY GORDON