Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | E4623 | TX |
N | 207Q00000X | Family Doctor | E4623 | TX |
NPI | 1083666374 |
---|---|
Provider Name | Ann Marie Reed |
First Address | Bryan, TX 77807-4824 |
Second Address | College Station, TX 77843-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116555704 | (05) | TX |
116555705 | (05) | TX |
C20947 | (02) | TX |