Provider Demographics
NPI:1609360171
Name:REID, WILLIAM LLOYD JR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LLOYD
Last Name:REID
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866-0282
Mailing Address - Country:US
Mailing Address - Phone:480-529-4044
Mailing Address - Fax:866-580-3084
Practice Address - Street 1:7316 HOLLOMAN DR
Practice Address - Street 2:
Practice Address - City:IVOR
Practice Address - State:VA
Practice Address - Zip Code:23866-0282
Practice Address - Country:US
Practice Address - Phone:480-529-4044
Practice Address - Fax:866-580-3084
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT64728716347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle