Provider Demographics
NPI:1265666820
Name:REEDER, VIRGINIA JONES (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JONES
Last Name:REEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LOUISE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 PROVIDENCE PARK DR E
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4614
Practice Address - Country:US
Practice Address - Phone:251-631-3570
Practice Address - Fax:251-631-3572
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30643207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I018161OtherMEDICARE