Provider Demographics
NPI:1437223146
Name:REED, JONATHAN JUDE (MD)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JUDE
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REMIT DRIVE
Mailing Address - Street 2:LOCKBOX 1940
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1940
Mailing Address - Country:US
Mailing Address - Phone:866-916-5255
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:314-525-1900
Practice Address - Fax:314-525-4868
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008841207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
215050155OtherCPIN @ ST ANTHONYS
MO1437223146Medicaid
MO206271801Medicaid
MO206271801Medicaid
MO132100016Medicare PIN
MO132130015Medicare PIN
H55111Medicare UPIN
MO964243209Medicare PIN