Provider Demographics
NPI:1063577799
Name:REED, ALPHONSE MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:MICHAEL
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4782
Mailing Address - Country:US
Mailing Address - Phone:601-445-7352
Mailing Address - Fax:601-445-7353
Practice Address - Street 1:55 SGT PRENTISS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4782
Practice Address - Country:US
Practice Address - Phone:601-445-7352
Practice Address - Fax:601-445-7353
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS10009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS13542Medicaid
MS13542Medicaid
MS110000144Medicare PIN