Healthcare Provider Details

I. General information

NPI: 1184860728
Provider Name (Legal Business Name): BERT THOMAS REED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2009
Last Update Date: 01/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 RABBIT HOP RD
SPRUCE PINE NC
28777-8616
US

IV. Provider business mailing address

2143 RABBIT HOP RD
SPRUCE PINE NC
28777-8616
US

V. Phone/Fax

Practice location:
  • Phone: 828-773-2933
  • Fax:
Mailing address:
  • Phone: 828-773-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5146
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: