Provider Demographics
NPI:1023064227
Name:REED, TERESA ANNE (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-779-2465
Practice Address - Street 1:1400 GEORGE DIETER DR
Practice Address - Street 2:STE. 170
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-921-7855
Practice Address - Fax:915-921-7866
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ54562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110543904Medicaid
TX8B1105Medicare PIN
D16529Medicare UPIN
TX110543904Medicaid