Provider Demographics
NPI:1598007437
Name:REED, GUDRUN (MD)
Entity type:Individual
Prefix:
First Name:GUDRUN
Middle Name:
Last Name:REED
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8842
Mailing Address - Country:US
Mailing Address - Phone:305-300-1934
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:PO BOX 2742
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-0326
Practice Address - Country:US
Practice Address - Phone:541-412-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD215496207Q00000X
LA303243207Q00000X
CAA171172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2329588Medicaid
LA2329588Medicaid