Healthcare Provider Details

I. General information

NPI: 1487186839
Provider Name (Legal Business Name): JUSTIN W REED D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S MAIN ST LOWR LEVEL
JOPLIN MO
64801-4565
US

IV. Provider business mailing address

1027 S MAIN ST LOWR LEVEL
JOPLIN MO
64801-4565
US

V. Phone/Fax

Practice location:
  • Phone: 417-605-7123
  • Fax:
Mailing address:
  • Phone: 417-605-7123
  • Fax: 417-605-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number05-47164
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2022021802
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: