Healthcare Provider Details

I. General information

NPI: 1124221262
Provider Name (Legal Business Name): JUSTIN SCOTT REID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 S 109TH EAST AVE
TULSA OK
74146-5822
US

IV. Provider business mailing address

4802 S 109TH EAST AVE
TULSA OK
74146-5822
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-1400
  • Fax: 918-392-1401
Mailing address:
  • Phone: 918-392-1400
  • Fax: 918-392-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14311
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number29032
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: