Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN16424 | FL |
NPI | 1063690709 |
---|---|
Provider Name | Juddson Reed |
First Address | Ocala, FL 34471-5519 |
Second Address | Ocala, FL 34471-5519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2008 |
Last Update Date | 05/02/2008 |