Healthcare Provider Details

I. General information

NPI: 1699774885
Provider Name (Legal Business Name): HERMAN L REID III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HERMAN L REID III MD

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7839 S PROFESSIONAL DR
FORT BRANCH IN
47648-8405
US

IV. Provider business mailing address

7839 S PROFESSIONAL DR
FORT BRANCH IN
47648-8405
US

V. Phone/Fax

Practice location:
  • Phone: 812-753-5903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01056394A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01056394A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: