Jack R Reid Jr MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

JACK R REID JR MD LLC

Practice address

5000 Odonavan Blvd Ste 307
Walker, LA 70785-6355

Phone

(225) 791-3117

Fax

(225) 791-3122

NPI assigned

Oct 2, 2007

Last updated

Apr 30, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack R Reid, MDNPI 1518968262

Title

Owner

Phone

(225) 791-3117

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack R Reid Jr., MD

  • Internal Medicine Physician
  • Walker, LA
  • NPI 1518968262
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1356538433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 68",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731010068",
            "telephone_number": "225-791-3117",
            "fax_number": "225-791-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 ODONAVAN BLVD STE 307",
            "city": "WALKER",
            "state": "LA",
            "postal_code": "707856355",
            "telephone_number": "225-791-3117",
            "fax_number": "225-791-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK R REID JR MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-791-3117",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Walker, LA
• Providers in Walker, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.