Provider Demographics
NPI:1316174352
Name:REED, JEWMAULL JOSIAH (MD)
Entity type:Individual
Prefix:
First Name:JEWMAULL
Middle Name:JOSIAH
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 STONY POINT RD
Mailing Address - Street 2:STE E
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4120
Mailing Address - Country:US
Mailing Address - Phone:707-525-0211
Mailing Address - Fax:707-525-0491
Practice Address - Street 1:260 HOSPITAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4568
Practice Address - Country:US
Practice Address - Phone:707-463-7490
Practice Address - Fax:707-463-6674
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA135968207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program