Provider Demographics
NPI:1215996434
Name:REED, MYRA A (MD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:A
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 THOMAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408
Mailing Address - Country:US
Mailing Address - Phone:850-249-5000
Mailing Address - Fax:850-249-5008
Practice Address - Street 1:1814 THOMAS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-5825
Practice Address - Country:US
Practice Address - Phone:850-249-5000
Practice Address - Fax:850-249-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57769207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10807OtherBCBS FLORIDA
FL10807TMedicare PIN
FL10807OtherBCBS FLORIDA