Provider Demographics
NPI:1689139123
Name:REED, JEFFREY DALTON (BS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DALTON
Last Name:REED
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 N. 2280 RD
Mailing Address - Street 2:
Mailing Address - City:CUSTER CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73639
Mailing Address - Country:US
Mailing Address - Phone:405-306-0911
Mailing Address - Fax:
Practice Address - Street 1:1501 LERA STE 5
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2671
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator