Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD038406E | PA |
Y | 2086S0127X | Trauma Surgeon | MD038406E | PA |
NPI | 1063476349 |
---|---|
Provider Name | John Spence Reid |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 31/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014092810001 | (05) | PA |
F56161 | (02) |