Provider Demographics
NPI:1902964661
Name:REID, YVONNE CAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:CAROLINA
Last Name:REID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 W OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3108
Mailing Address - Country:US
Mailing Address - Phone:303-866-7561
Mailing Address - Fax:303-866-7197
Practice Address - Street 1:3520 W OXFORD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3108
Practice Address - Country:US
Practice Address - Phone:303-866-7561
Practice Address - Fax:303-866-7197
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO409482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34154035Medicaid
COF28921Medicare UPIN