Provider Demographics
NPI:1891754040
Name:REID, GENE WATKINS (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:WATKINS
Last Name:REID
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 1:10201 W MARKHAM ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2195
Mailing Address - Country:US
Mailing Address - Phone:501-227-6916
Mailing Address - Fax:501-227-8254
Practice Address - Street 1:10201 W MARKHAM ST
Practice Address - Street 2:SUITE 212
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2195
Practice Address - Country:US
Practice Address - Phone:501-227-6916
Practice Address - Fax:501-227-8254
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC55792084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD04868Medicare UPIN
AR54248Medicare ID - Type Unspecified