Provider Demographics
NPI:1497789804
Name:REED, GREGORY STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:STEPHEN
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 1:7480 FAIRWAY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6879
Mailing Address - Country:US
Mailing Address - Phone:305-557-1212
Mailing Address - Fax:305-825-3011
Practice Address - Street 1:7480 FAIRWAY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6879
Practice Address - Country:US
Practice Address - Phone:305-557-1212
Practice Address - Fax:305-825-3011
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79126Medicare ID - Type Unspecified
FLD58660Medicare UPIN