Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 125-053205 | IL |
N | 207ND0101X | MOHS-Micrographic Surgeon | 036-127825 | IL |
NPI | 1295927721 |
---|---|
Provider Name | Julia Erin Reid |
First Address | Kingsport, TN 37660-2360 |
Second Address | Kingsport, TN 37660-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 31/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036127825 | (05) | IL |
1295927721 | (05) | VA |