Basic Information
| Provider Information | |||||||||
| NPI: | 1417995317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 N MONTE VISTA ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367101 | ||||||||
| FaxNumber: | 5804364447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 14TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 734011828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802206132 | ||||||||
| FaxNumber: | 5802206772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 02/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 12645 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 208M00000X | 12645 | OK | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.