Healthcare Provider Details

I. General information

NPI: 1285071381
Provider Name (Legal Business Name): BENJAMIN LEE REESER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 12/16/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 E KIERLAND BLVD APT 213
SCOTTSDALE AZ
85254-2988
US

IV. Provider business mailing address

809 W RIORDAN RD STE 100-132
FLAGSTAFF AZ
86001-0842
US

V. Phone/Fax

Practice location:
  • Phone: 480-418-6985
  • Fax: 480-546-3144
Mailing address:
  • Phone: 623-396-5623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52054
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number52054
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52054
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: