Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A78619 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A78619 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A78619 | CA |
NPI | 1336151455 |
---|---|
Provider Name | Dr. James Reid |
First Address | Culver City, CA 90232-6803 |
Second Address | Culver City, CA 90232-6803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 27/06/2020 |