Provider Demographics
NPI:1891771713
Name:REED, MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1275N ROSE DR 136
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3919
Mailing Address - Country:US
Mailing Address - Phone:714-528-3668
Mailing Address - Fax:714-528-0739
Practice Address - Street 1:1275N ROSE DR 136
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3919
Practice Address - Country:US
Practice Address - Phone:714-528-3668
Practice Address - Fax:714-528-0739
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3696213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0378480001OtherDMERC SUPPLER NUMBER
CA19003OtherDMERC CONTRACTOR NUMBER
CA0378480001OtherDMERC SUPPLER NUMBER
CA0378480001Medicare NSC