Healthcare Provider Details

I. General information

NPI: 1033196894
Provider Name (Legal Business Name): DALE L REINKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 E CHERRY ST
TROY MO
63379-1520
US

IV. Provider business mailing address

1175 E CHERRY ST P.O. BOX 315
TROY MO
63379-1520
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-7722
  • Fax: 636-528-7744
Mailing address:
  • Phone: 636-528-7722
  • Fax: 636-528-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: