MEDICARE: JEFF REID DO PLLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1518538339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF REID DO PLLC

Provider Business Mailing Address
First Line	:	17413 HAWKS VIEW CT
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-0605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14000 N PORTLAND AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-4004
Country	:	US
Telephone Number	:	405-936-8100
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	JERI YATES
Credential	:
Telephone Number	:	580-272-0485

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	04/26/2023

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