Healthcare Provider Details

I. General information

NPI: 1255795050
Provider Name (Legal Business Name): REED COAST DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 LAS GALLINAS AVE STE 115
SAN RAFAEL CA
94903-3431
US

IV. Provider business mailing address

2299 POST ST STE 205
SAN FRANCISCO CA
94115-3473
US

V. Phone/Fax

Practice location:
  • Phone: 415-472-5595
  • Fax:
Mailing address:
  • Phone: 208-691-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL6799
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: