Provider Demographics
NPI:1891247425
Name:REID, DANIEL S (IDMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:REID
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 14067
Mailing Address - Street 2:BLDG 23010
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96543
Mailing Address - Country:US
Mailing Address - Phone:671-633-2124
Mailing Address - Fax:
Practice Address - Street 1:26012 CAROLINES AVE.
Practice Address - Street 2:ANDERSEN AFB
Practice Address - City:YIGO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-366-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians