Provider Demographics
NPI:1639379365
Name:REED, JORDAN KORY (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:KORY
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 1:24935 TOUTANT BEAUREGARD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3401
Mailing Address - Country:US
Mailing Address - Phone:830-981-9443
Mailing Address - Fax:830-981-9443
Practice Address - Street 1:24935 TOUTANT BEAUREGARD RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3401
Practice Address - Country:US
Practice Address - Phone:830-981-9443
Practice Address - Fax:830-981-9443
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9518208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20940Medicare UPIN