Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34002459R | OH |
NPI | 1073514709 |
---|---|
Provider Name | Kevin M Reid |
First Address | Dayton, OH 45405-4775 |
Second Address | Dayton, OH 45405-4775 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 10/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000008389 | ANTHEM BLUE SHIELD (01) | OH |
0396076 | (05) | OH |
D89753 | (02) | OH |