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General NPI Number Information
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NPI Number | 1629039607
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Entity Type | Individual
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Provider Name | JEFFREY W MEINCKE-REZA MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 835 PARKSIDE ST
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City | RIPON
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State | WI
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Zip | 54971-8505
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Country | US
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Telephone | 920-745-3500
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Fax | 920-745-7930
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Provider Business Mailing Address
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Address Line | 835 PARKSIDE ST
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City | RIPON
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State | WI
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Zip | 54971-8505
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Country | US
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Telephone | 920-745-3500
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Fax | 920-926-8370
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 41012
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | K6887
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License Number State | TX
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