Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 45238D48 | PA |
NPI | 1639731516 |
---|---|
Provider Name | Bob Harry Reid |
First Address | Fairfield, PA 17320-0531 |
Second Address | Fairfield, PA 17320-8222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2019 |
Last Update Date | 01/07/2019 |