Provider Demographics
NPI:1659423556
Name:REED, JUBEL KEITH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JUBEL
Middle Name:KEITH
Last Name:REED
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6625
Mailing Address - Country:US
Mailing Address - Phone:432-684-4488
Mailing Address - Fax:432-684-6644
Practice Address - Street 1:1300 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6625
Practice Address - Country:US
Practice Address - Phone:432-684-4488
Practice Address - Fax:432-684-6644
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03316OtherPA LICENSE NUMBER
TXP82484Medicare UPIN
TXPA03316OtherPA LICENSE NUMBER