Provider Demographics
NPI:1356807671
Name:REED, PRESLEY ORELLE JR (MD)
Entity type:Individual
Prefix:
First Name:PRESLEY
Middle Name:ORELLE
Last Name:REED
Suffix:JR
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 1:375 BELLEVUE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7819
Mailing Address - Country:US
Mailing Address - Phone:303-447-0904
Mailing Address - Fax:
Practice Address - Street 1:495 W SANTA ELENA RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-2925
Practice Address - Country:US
Practice Address - Phone:720-620-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC344992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry