# JACK R REID JR MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356538433
- **Authorized official:** JACK R REID MD (OWNER)
- **Authorized official phone:** (225) 791-3117

## Contact information

- **Practice address:** 5000 ODONAVAN BLVD STE 307, WALKER, LA 70785-6355
- **Practice address phone:** (225) 791-3117
- **Practice address fax:** (225) 791-3122
- **Mailing address:** PO BOX 68, OKLAHOMA CITY, OK 73101-0068
- **Mailing address phone:** (225) 791-3117
- **Mailing address fax:** (225) 791-3122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/02/2007
- **Last updated:** 04/30/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DF0604 | RAILROAD MCARE | LA |
| 01 | — | G5769 | BCBS | LA |