Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME57769 | FL |
NPI | 1215996434 |
---|---|
Provider Name | Dr. Myra A Reed |
First Address | Panama City Beach, FL 32408 |
Second Address | Panama City Beach, FL 32408-5825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2006 |
Last Update Date | 14/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10807 | BCBS FLORIDA (01) | FL |
E71123 | (02) | FL |