Healthcare Provider Details

I. General information

NPI: 1942585963
Provider Name (Legal Business Name): HERMAN L. REID III MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7839 S PROFESSIONAL DR
FORT BRANCH IN
47648-8405
US

IV. Provider business mailing address

18920 ROSCOMMON RD
EVANSVILLE IN
47725-6417
US

V. Phone/Fax

Practice location:
  • Phone: 812-306-6631
  • Fax: 812-867-6951
Mailing address:
  • Phone: 812-306-6631
  • Fax: 812-867-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01056394A
License Number StateIN

VIII. Authorized Official

Name: MRS. MARIA E PENN-REID
Title or Position: OFFICE MANAGER
Credential: BA
Phone: 812-306-6631