Provider Demographics
NPI:1154355287
Name:REID, FRED MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:MICHAEL
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAMILLE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2702
Mailing Address - Country:US
Mailing Address - Phone:318-448-8548
Mailing Address - Fax:318-448-8548
Practice Address - Street 1:311 CAMILLE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-2702
Practice Address - Country:US
Practice Address - Phone:318-448-8548
Practice Address - Fax:318-448-8548
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012225207P00000X
MS07848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1344257Medicaid
LAB61517Medicare UPIN
LA5L863Medicare ID - Type Unspecified