Doctor Name: | STEPHEN LARRY REID |
NPI Number: | 1750513131 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | 642078 |
Business Practice Address: | 3128 Saba Ln Port Neches, TX - 776515422 |
Business Phone Number: | 4097241404 |
Business Fax Number: | |
Mailing Address: | 2800 Hickory, NEDERLAND |
State: | TX |
Postal Code: | 776274782 |
Phone Number: | 4097226789 |
Fax Number: | |
NPI Enumeration Date: | 08/18/2009 |
NPI Last Update Date: | 07/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 642078 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |