Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 013643 | MO |
N | 1223D0001X | Dental Public Health | 013643 | MO |
N | 1223G0001X | General Practice | 013643 | MO |
N | 213EG0000X | General Practice | 013643 | MO |
NPI | 1609972363 |
---|---|
Provider Name | William R Reed |
First Address | Poplar Bluff, MO 63901-3342 |
Second Address | Poplar Bluff, MO 63901-3318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |