Provider Demographics
NPI:1467477224
Name:REID, DOUGLAS ALAN (DPM)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALAN
Last Name:REID
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 AQUIDNECK AVE
Mailing Address - Street 2:BOX 15
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-738-7750
Mailing Address - Fax:401-738-9750
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:BOX 15
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-849-2157
Practice Address - Fax:401-848-8441
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00276213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDR12048Medicaid
489007170Medicare ID - Type Unspecified
489021286Medicare ID - Type UnspecifiedGROUP #
RIDR12048Medicaid
RI0446510001Medicare NSC