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General NPI Number Information
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NPI Number | 1629115670
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Entity Type | Individual
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Provider Name | DENNIS REED PA
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 314 E MAIN ST
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City | PORTAGEVILLE
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State | MO
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Zip | 63873-1616
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Country | US
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Telephone | 573-379-3777
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Fax | 573-379-9331
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Provider Business Mailing Address
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Address Line | 1008 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5044
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Country | US
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Telephone | 573-472-7406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | DA 105031
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License Number State | MO
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