Provider Demographics
NPI:1356355796
Name:REED, ALICE J (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:J
Last Name:REED
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:357 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5153
Mailing Address - Country:US
Mailing Address - Phone:904-249-6556
Mailing Address - Fax:904-270-2263
Practice Address - Street 1:357 11TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-5153
Practice Address - Country:US
Practice Address - Phone:904-249-6556
Practice Address - Fax:904-270-2263
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2012-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME60110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057999800Medicaid
FL057999800Medicaid
FLE91540Medicare UPIN