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Organization
JACK R REID JR MD LLC
Active
Organization
JACK R REID JR MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK R REID MD (OWNER)
(225) 791-3117
Entity
Organization
Contact information
Practice address
5000 ODONAVAN BLVD STE 307, WALKER, LA 70785-6355
(225) 791-3117
(225) 791-3122
Mailing address
PO BOX 68, OKLAHOMA CITY, OK 73101-0068
(225) 791-3117
(225) 791-3122
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF0604
RAILROAD MCARE
LA
01
—
G5769
BCBS
LA
Enumeration date
10/02/2007
Last updated
04/30/2020
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