Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 14311 | HI |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 29032 | OK |
NPI | 1124221262 |
---|---|
Provider Name | Dr. Justin Scott Reid |
First Address | Tulsa, OK 74146-5822 |
Second Address | Tulsa, OK 74146-5822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 21/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200588760A | (05) | OK |