Healthcare Provider Details

I. General information

NPI: 1255047064
Provider Name (Legal Business Name): MARTIN REED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 CAMERON ST # B
MONROE LA
71201-3963
US

IV. Provider business mailing address

3204 CAMERON ST # B
MONROE LA
71201-3963
US

V. Phone/Fax

Practice location:
  • Phone: 318-450-1088
  • Fax:
Mailing address:
  • Phone: 318-450-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number008481025
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: