Healthcare Provider Details

I. General information

NPI: 1235358243
Provider Name (Legal Business Name): GARY L REASOR, MD P.S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EXECUTIVE PARK
LOUISVILLE KY
40207-4204
US

IV. Provider business mailing address

400 EXECUTIVE PARK
LOUISVILLE KY
40207-4204
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-9877
  • Fax: 502-896-9982
Mailing address:
  • Phone: 502-896-9877
  • Fax: 502-896-9972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY L REASOR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-896-9877