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General NPI Number Information
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NPI Number | 1356538433
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Entity Type | Organization
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Legal Business Name | JACK R REID JR MD LLC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 5000 ODONAVAN BLVD STE 307
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City | WALKER
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State | LA
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Zip | 70785-6355
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Country | US
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Telephone | 225-791-3117
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Fax | 225-791-3122
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | OKLAHOMA CITY
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State | OK
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Zip | 73101-0068
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Country | US
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Telephone | 225-791-3117
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Fax | 225-791-3122
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Authorized Official
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Title or Position | OWNER
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Name | JACK R REID
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Credential | MD
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Telephone | 225-791-3117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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