Basic Information
Provider Information
NPI: 1316028483
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: HOLLIS
MiddleName: THEODORE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 69004
Address2:  
City: ALEXANDRIA
State: LA
PostalCode: 713069004
CountryCode: US
TelephoneNumber: 3184730010
FaxNumber: 3184835031
Practice Location
Address1: 2495 SHREVEPORT HIGHWAY
Address2:  
City: ALEXANDRIA
State: LA
PostalCode: 713069004
CountryCode: US
TelephoneNumber: 3184730010
FaxNumber: 3184835031
Other Information
ProviderEnumerationDate: 10/17/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X013715LAY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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