Healthcare Provider Details

I. General information

NPI: 1104824598
Provider Name (Legal Business Name): BRIAN JAY REACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date: 03/31/2006
Reactivation Date: 05/01/2006

III. Provider practice location address

300 W OAK ST
CARBONDALE IL
62901-1400
US

IV. Provider business mailing address

201 E MADISON ST STE 328
SPRINGFIELD IL
62702-5131
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 217-545-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-099587
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: