Healthcare Provider Details

I. General information

NPI: 1114915931
Provider Name (Legal Business Name): REED B GRAHAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 CANTON RD STE 1
AKRON OH
44312-2632
US

IV. Provider business mailing address

696 CANTON RD STE 1
AKRON OH
44312-2632
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-8202
  • Fax: 330-535-3065
Mailing address:
  • Phone: 330-535-8202
  • Fax: 330-535-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-0002836
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-00-2836-G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: