Healthcare Provider Details

I. General information

NPI: 1417995317
Provider Name (Legal Business Name): KEVIN H REED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 14TH AVE NW
ARDMORE OK
73401-1828
US

IV. Provider business mailing address

530 N MONTE VISTA ST SUITE A
ADA OK
74820-4675
US

V. Phone/Fax

Practice location:
  • Phone: 580-220-6132
  • Fax: 580-220-6772
Mailing address:
  • Phone: 580-436-7101
  • Fax: 580-436-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number12645
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12645
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: