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General NPI Number Information
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NPI Number | 1164470480
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Entity Type | Individual
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Provider Name | JUSTIN MICHAEL RECKARD MD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 71943 HIGHWAY 111
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4848
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Country | US
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Telephone | 760-776-7600
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Fax | 760-776-7640
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Provider Business Mailing Address
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Address Line | 71943 HIGHWAY 111
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4848
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Country | US
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Telephone | 760-776-7600
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Fax | 760-776-7640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A120374
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 13458
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License Number State | HI
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