Provider Demographics
NPI:1336180843
Name:DIMMITT, REED ALLEN (MD)
Entity type:Individual
Prefix:
First Name:REED
Middle Name:ALLEN
Last Name:DIMMITT
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 1:1600 7TH AVE S # 5604
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-638-9918
Mailing Address - Fax:205-975-8991
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9918
Practice Address - Fax:205-638-7455
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL239952080N0001X
ALMD.239952080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H312505OtherVIVA
AL00124527OtherMISSISSIPPI MEDICAID
AL4710065OtherUHC
AL7721281OtherAETNA
AL9962020Medicaid
AL4710065OtherUHC
AL4710065OtherUHC
AL9962020Medicaid