Provider Demographics
NPI:1841227550
Name:REED, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4603
Mailing Address - Country:US
Mailing Address - Phone:850-257-7097
Mailing Address - Fax:850-257-7191
Practice Address - Street 1:500 W 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4603
Practice Address - Country:US
Practice Address - Phone:850-257-7097
Practice Address - Fax:850-257-7191
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115111207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054282200Medicaid
FL12146OtherBLUE SHIELD
FL054282200Medicaid
FL12146Medicare ID - Type Unspecified