Healthcare Provider Details

I. General information

NPI: 1588626576
Provider Name (Legal Business Name): MS. CRYSTAL D. REED
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N BURKHARDT RD
EVANSVILLE IN
47715-2740
US

IV. Provider business mailing address

906 S HEBRON AVE
EVANSVILLE IN
47714-4079
US

V. Phone/Fax

Practice location:
  • Phone: 812-474-1110
  • Fax: 812-474-1303
Mailing address:
  • Phone: 812-476-1367
  • Fax: 812-477-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01042351
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: