Provider Demographics
NPI:1801810957
Name:REED, MARCUS WAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:WAYNE
Last Name:REED
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 WELLS CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6943
Mailing Address - Country:US
Mailing Address - Phone:972-293-6675
Mailing Address - Fax:
Practice Address - Street 1:7441 MARVIN D LOVE FWY STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3770
Practice Address - Country:US
Practice Address - Phone:972-572-1998
Practice Address - Fax:972-572-4842
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02941363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical