Healthcare Provider Details

I. General information

NPI: 1942434568
Provider Name (Legal Business Name): REEDER VEIN INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 OAKMONT BLVD STE 204
FT WORTH TX
76132-3911
US

IV. Provider business mailing address

7100 OAKMONT BLVD STE 204
FT WORTH TX
76132-3911
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-3040
  • Fax: 682-499-5921
Mailing address:
  • Phone: 972-566-3040
  • Fax: 682-499-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberD5822
License Number StateTX

VIII. Authorized Official

Name: JUDY R COCKBURN
Title or Position: MANAGER
Credential:
Phone: 575-770-4393