Provider Demographics
NPI:1902860919
Name:REED, GARY LESLIE (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LESLIE
Last Name:REED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14045 N 7TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4388
Mailing Address - Country:US
Mailing Address - Phone:602-866-0961
Mailing Address - Fax:602-866-9820
Practice Address - Street 1:14045 N 7TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4388
Practice Address - Country:US
Practice Address - Phone:602-866-0961
Practice Address - Fax:602-866-9820
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD47133Medicare UPIN