Provider Demographics
NPI:1699421545
Name:REED, LARRY WAYNE JR
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:WAYNE
Last Name:REED
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NORMANDY ST APT 517
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3471
Mailing Address - Country:US
Mailing Address - Phone:713-412-3513
Mailing Address - Fax:
Practice Address - Street 1:450 NORMANDY ST APT 517
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3471
Practice Address - Country:US
Practice Address - Phone:713-412-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date: