=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902860919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY LESLIE REED D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2006
-----------------------------------------------------
Last Update Date | 10/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14045 N 7TH ST SUITE #1
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-866-0961
-----------------------------------------------------
Fax | 602-866-9820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14045 N 7TH ST SUITE #1
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-866-0961
-----------------------------------------------------
Fax | 602-866-9820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2019
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------