Provider Demographics
NPI:1538472899
Name:REID, CHAD R (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:REID
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5602 SW LEE BLVD
Mailing Address - Street 2:ATTN: PRACTICE MANAGEMENT
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9635
Mailing Address - Country:US
Mailing Address - Phone:580-531-4890
Mailing Address - Fax:580-531-4981
Practice Address - Street 1:5602 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9635
Practice Address - Country:US
Practice Address - Phone:580-531-4890
Practice Address - Fax:580-531-4981
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2024-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010020758207Q00000X
IN01083618A207Q00000X
OK30134208M00000X, 207QA0505X
LA341649208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
33145YNLTMedicare PIN