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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

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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