Provider Demographics
NPI:1497755805
Name:REID, DAVID S IV (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:REID
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 BILL FRIES DR BLDG E
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2731
Mailing Address - Country:US
Mailing Address - Phone:843-681-4088
Mailing Address - Fax:843-689-3742
Practice Address - Street 1:35 BILL FRIES DR BLDG E
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2731
Practice Address - Country:US
Practice Address - Phone:843-681-4088
Practice Address - Fax:843-689-3742
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58471208200000X, 2086S0122X
SC361502082S0105X, 208200000X
IL036.1188092086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971096Medicaid
ILIL2868023Medicare PIN
NC8971096Medicaid
NC2211514Medicare ID - Type Unspecified