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General NPI Number Information
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NPI Number | 1619345501
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Entity Type | Organization
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Legal Business Name | REESE FAMILY PRACTICE PC
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 1755 COBURG RD BLDG 6B
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City | EUGENE
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State | OR
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Zip | 97401-4982
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Country | US
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Telephone | 541-255-3905
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Fax | 541-357-5527
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Provider Business Mailing Address
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Address Line | PO BOX 40386
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City | EUGENE
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State | OR
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Zip | 97404-0060
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Country | US
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Telephone | 541-255-0395
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Fax | 541-357-5527
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Authorized Official
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Title or Position | PRCTICE ADMINISTRATOR
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Name | RIK LARSON
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Credential |
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Telephone | 541-255-3905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD17594
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License Number State | OR
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