Healthcare Provider Details

I. General information

NPI: 1255307468
Provider Name (Legal Business Name): DAVID L REESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W OLYMPIC DR
LANARK IL
61046-9105
US

IV. Provider business mailing address

421 W EXCHANGE ST PO BOX 268
FREEPORT IL
61032-4030
US

V. Phone/Fax

Practice location:
  • Phone: 815-493-2831
  • Fax:
Mailing address:
  • Phone: 815-599-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036063843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: