Provider Demographics
NPI:1639731516
Name:REID, BOB HARRY
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:HARRY
Last Name:REID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17320-0531
Mailing Address - Country:US
Mailing Address - Phone:717-933-1451
Mailing Address - Fax:
Practice Address - Street 1:48 LAKESIDE TRL
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:PA
Practice Address - Zip Code:17320-8222
Practice Address - Country:US
Practice Address - Phone:717-933-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA45238D48207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty