Individual
JACK R REID JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5000 ODONAVAN BLVD STE 307, WALKER, LA 70785-6355
(225) 791-3117
(225) 791-3122
Mailing address
PO BOX 877, DENHAM SPRINGS, LA 70727-0877
(225) 791-3117
(225) 791-3122
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L018291
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1928135
—
LA
01
—
P00335585
RAILROAD MCARE
LA
Enumeration date
08/03/2005
Last updated
05/26/2022
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