Provider Demographics
NPI:1417935735
Name:REID, RICHARD ALTON (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALTON
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:REID BUILDING, STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-253-6910
Mailing Address - Fax:904-253-6964
Practice Address - Street 1:1325 SAN MARCO BLVD
Practice Address - Street 2:REID BUILDING, STE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8568
Practice Address - Country:US
Practice Address - Phone:904-253-6910
Practice Address - Fax:904-253-6964
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031315207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15425OtherBCBS OF FLORIDA
FL593385828OtherOTHER COMMERCIAL INS.
FL037602700Medicaid
FL15425OtherBCBS OF FLORIDA
FL15425OtherBCBS OF FLORIDA