Provider Demographics
NPI:1902877608
Name:REED, JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:REED
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5160
Mailing Address - Fax:601-815-6985
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF OTOLARYNGOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5160
Practice Address - Fax:601-815-6985
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-02-11
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Provider Licenses
StateLicense IDTaxonomies
MS12533207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL155387Medicaid
MS05457340Medicaid
AL155387Medicaid
MS05457340Medicaid
MS327907YJ5DMedicare PIN