Healthcare Provider Details

I. General information

NPI: 1396739066
Provider Name (Legal Business Name): CANDACE M REID D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DIVISION ST
PRESCOTT AZ
86301-1601
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-775-5567
  • Fax: 928-772-1522
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number3518
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: