Healthcare Provider Details

I. General information

NPI: 1457510539
Provider Name (Legal Business Name): GENE W REID MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 W MARKHAM ST STE 212
LITTLE ROCK AR
72205-2181
US

IV. Provider business mailing address

10201 W MARKHAM ST STE 212
LITTLE ROCK AR
72205-2181
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-6916
  • Fax: 501-227-8254
Mailing address:
  • Phone: 501-227-6916
  • Fax: 501-227-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC5579
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC5579
License Number StateAR

VIII. Authorized Official

Name: DR. GENE W REID
Title or Position: OWNER
Credential: MD
Phone: 501-227-6916