Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12011577A | IN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 101997 | CA |
N | 207L00000X | Anesthesiologist | 1870 | CA |
NPI | 1134381841 |
---|---|
Provider Name | Mr. John Allan Reid |
First Address | Sunnyvale, CA 94087 |
Second Address | Sunnyvale, CA 94087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 15/05/2019 |