MEDICARE: LINDA REED P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA01939	TX

General Provider Information

NPI Number	:	1881603785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA REED P.A.

Provider Business Mailing Address
First Line	:	3500 CAMP BOWIE BLVD
Second Line	:	EAD 324
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2644
Country	:	US
Telephone Number	:	817-735-0170
Fax Number	:	817-735-0111

Provider Business Practice Location Address
First Line	:	3500 CAMP BOWIE BLVD
Second Line	:	ENX1 109
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2644
Country	:	US
Telephone Number	:	817-735-0310
Fax Number	:	817-735-2529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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