MEDICARE: JACK R REID JR MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G5769	OTHER	LA	BCBS
2	DF0604	OTHER	LA	RAILROAD MCARE

General Provider Information

NPI Number	:	1356538433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK R REID JR MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-0068
Country	:	US
Telephone Number	:	225-791-3117
Fax Number	:	225-791-3122

Provider Business Practice Location Address
First Line	:	5000 ODONAVAN BLVD STE 307
Second Line	:
City	:	WALKER
State	:	LA
Zip	:	70785-6355
Country	:	US
Telephone Number	:	225-791-3117
Fax Number	:	225-791-3122

Authorized Official
Title or Position	:	OWNER
Name	:	JACK R REID
Credential	:	MD
Telephone Number	:	225-791-3117

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	04/30/2020

Similar Medicare Providers

1518968262 — JACK R REID JR. MD
Practice Location Address:

5000 ODONAVAN BLVD STE 307
WALKER, LA
70785-6355

Practice Phone: 225-791-3117
Practice Fax: 225-791-3122

1538471495 — ERIN LAGROUE NP
Practice Location Address:

5000 ODONAVAN BLVD STE 404
WALKER, LA
70785-6355

Practice Phone: 225-369-8100
Practice Fax: 225-369-8140

1669827705 — MRS. ELIZABETH ROBERTS LCSW
Practice Location Address:

5000 ODONAVAN BLVD STE 404
WALKER, LA
70785-6355

Practice Phone: 225-765-5500
Practice Fax: 225-369-8140

1346761301 — KORI FOGG JUBAN
Practice Location Address:

5000 ODONAVAN BLVD STE 404
WALKER, LA
70785-6355

Practice Phone: 225-369-8100
Practice Fax:

1245856434 — LABORATORY CORPORATION OF AMERICA HOLDINGS
Practice Location Address:

5000 ODONAVAN BLVD STE 104
WALKER, LA
70785-6355

Practice Phone: 225-667-1666
Practice Fax:

1851900385 — AMY L. MILLER FNP
Practice Location Address:

5000 ODONAVAN BLVD STE 404
WALKER, LA
70785-6355

Practice Phone: 225-369-8100
Practice Fax:

Directions to “JACK R REID JR MD LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.