Provider Demographics
NPI:1699774885
Name:REID, HERMAN L III (MD)
Entity type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:L
Last Name:REID
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HERMAN
Other - Middle Name:L
Other - Last Name:REID
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7839 S PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT BRANCH
Mailing Address - State:IN
Mailing Address - Zip Code:47648-8405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7839 S PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648-8405
Practice Address - Country:US
Practice Address - Phone:812-753-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056394A174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200389450Medicaid
IN200389450Medicaid
IN237890SMedicare PIN
INDF3251Medicare PIN