Provider Demographics
NPI:1013919604
Name:REED, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
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 1:3326 FRONT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-6487
Mailing Address - Country:US
Mailing Address - Phone:318-435-7333
Mailing Address - Fax:318-435-9061
Practice Address - Street 1:3326 FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-6487
Practice Address - Country:US
Practice Address - Phone:318-435-7333
Practice Address - Fax:318-435-9061
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-11-03
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
LA018290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940445Medicaid
LA57790Medicare ID - Type Unspecified
LA1940445Medicaid