Provider Demographics
NPI:1528036092
Name:REID, ELWOOD PAUL (M D)
Entity Type:Individual
Prefix:DR
First Name:ELWOOD
Middle Name:PAUL
Last Name:REID
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 LITHIA RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6401
Mailing Address - Country:US
Mailing Address - Phone:813-661-6863
Mailing Address - Fax:813-684-2984
Practice Address - Street 1:3911 LITHIA RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6401
Practice Address - Country:US
Practice Address - Phone:813-661-6863
Practice Address - Fax:813-684-2984
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1211207V00000X
CAA49781207V00000X
NC0098-01458207V00000X
IA32906207V00000X
VA0101237440207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528036092Medicaid
VA1528036092Medicaid
D08975Medicare UPIN