Provider Demographics
NPI:1538113634
Name:REED, JOHN D JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:REED
Suffix:JR
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 1:2200 RANDALLIA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4638
Mailing Address - Country:US
Mailing Address - Phone:260-373-4731
Mailing Address - Fax:
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-471-9466
Practice Address - Fax:260-484-5919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010345682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4249780100Medicaid
IN000000092608OtherANTHEM
OH2100603Medicaid
IN1742OtherPHP
IN924750PMedicare ID - Type Unspecified
IN190320QMedicare ID - Type Unspecified
IN925240LMedicare ID - Type Unspecified
IN163520PMedicare ID - Type Unspecified
MI4249780100Medicaid
OH2100603Medicaid
OHRE4111661Medicare ID - Type Unspecified
IN000000092608OtherANTHEM
IN194930NMedicare ID - Type Unspecified
IN147380QMedicare ID - Type Unspecified