Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12011774A | IN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 12011774A | IN |
NPI | 1033366711 |
---|---|
Provider Name | Dr. Lucas S Reed |
First Address | Fort Wayne, IN 46804-5792 |
Second Address | Fort Wayne, IN 46804-5792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2008 |
Last Update Date | 09/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201075180 | (05) | IN |