=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841544269
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER J REED DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2012
-----------------------------------------------------
Last Update Date | 02/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14045 N 7TH ST SUITE 3
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-795-5505
-----------------------------------------------------
Fax | 602-795-9277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14045 N 7TH ST SUITE 3
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-795-5505
-----------------------------------------------------
Fax | 602-795-9277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | DR. PETER JEFFREY REED
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 602-795-5505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 005940
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------