Healthcare Provider Details

I. General information

NPI: 1053055111
Provider Name (Legal Business Name): JOSHUA REIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 22ND ST
SIOUX FALLS SD
57105-1554
US

IV. Provider business mailing address

32 GOLF DR
WENTWORTH SD
57075-7300
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5737
  • Fax:
Mailing address:
  • Phone: 160-535-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: