Provider Demographics
NPI:1538112107
Name:ROGER B REED DPM PC
Entity Type:Organization
Organization Name:ROGER B REED DPM PC
Other - Org Name:HENDERSON FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATION PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:B
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-719-1349
Mailing Address - Street 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:#B-18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-719-1349
Mailing Address - Fax:702-558-1522
Practice Address - Street 1:2649 W HORIZON RIDGE PKWY
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4801
Practice Address - Country:US
Practice Address - Phone:702-565-6641
Practice Address - Fax:702-565-9249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
NV37387332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDA0668Medicare PIN
NV4856040001Medicare NSC
NVV37386Medicare PIN