Provider Demographics
NPI:1588626576
Name:REED, CRYSTAL D
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:D
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 S HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-4079
Mailing Address - Country:US
Mailing Address - Phone:812-476-1367
Mailing Address - Fax:812-477-4153
Practice Address - Street 1:700 N BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2740
Practice Address - Country:US
Practice Address - Phone:812-474-1110
Practice Address - Fax:812-474-1303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010423512085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS64877368Medicaid
KS64877368Medicaid
F44097Medicare UPIN