Healthcare Provider Details

I. General information

NPI: 1699719807
Provider Name (Legal Business Name): DANIEL C REED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S EAGLE RD
EAGLE ID
83616-6067
US

IV. Provider business mailing address

435 S EAGLE RD
EAGLE ID
83616-6067
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-8200
  • Fax: 208-939-8222
Mailing address:
  • Phone: 208-939-8200
  • Fax: 208-939-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM8871
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: