Healthcare Provider Details

I. General information

NPI: 1881651958
Provider Name (Legal Business Name): REUBEN C SETLIFF III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 E 26TH ST
SIOUX FALLS SD
57103-4016
US

IV. Provider business mailing address

2709 E 26TH ST
SIOUX FALLS SD
57103
US

V. Phone/Fax

Practice location:
  • Phone: 605-339-1872
  • Fax: 605-339-3872
Mailing address:
  • Phone: 605-339-1872
  • Fax: 605-339-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number3904
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: