Healthcare Provider Details

I. General information

NPI: 1306819453
Provider Name (Legal Business Name): ROBERT PAUL REID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 COUNTY RD 1
CRIPPLE CREEK CO
80813
US

IV. Provider business mailing address

1101 COUNTY RD 1
CRIPPLE CREEK CO
80813
US

V. Phone/Fax

Practice location:
  • Phone: 303-330-0271
  • Fax: 303-330-0371
Mailing address:
  • Phone: 303-330-0271
  • Fax: 303-330-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME72889
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0024755
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: