Healthcare Provider Details

I. General information

NPI: 1427767136
Provider Name (Legal Business Name): TERRY R. REED BOCPD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 FALLS BLVD S
WYNNE AR
72396-3505
US

IV. Provider business mailing address

804 FALLS BLVD S
WYNNE AR
72396-3505
US

V. Phone/Fax

Practice location:
  • Phone: 870-238-7085
  • Fax: 870-587-0112
Mailing address:
  • Phone: 870-238-7085
  • Fax: 870-587-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberOPP00273
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: