Provider Demographics
NPI:1245484096
Name:REED, KURTIS B (MD)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:B
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-814-7400
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:714 N COLLEGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5812
Practice Address - Country:US
Practice Address - Phone:208-814-7180
Practice Address - Fax:208-814-7199
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM11491207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
ID1245484096Medicaid
MNENROLLEDMedicaid
MNP00873574OtherRAILROAD MEDICARE
MNENROLLEDMedicaid
ID1245484096Medicaid