Provider Demographics
NPI:1629373428
Name:REED, JOHN RICHARD (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:REED
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 407
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0005
Mailing Address - Country:US
Mailing Address - Phone:0174-684-1538
Mailing Address - Fax:
Practice Address - Street 1:CMR 402 BOX 407
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-0005
Practice Address - Country:US
Practice Address - Phone:0174-684-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA085329367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered