=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669784351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS D. REEDER II, D.O., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2010
-----------------------------------------------------
Last Update Date | 07/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2212 NW 47TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-8848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-608-0894
-----------------------------------------------------
Fax | 405-608-0873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2212 NW 47TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-8848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-608-0894
-----------------------------------------------------
Fax | 405-608-0873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CHAIRMAN
-----------------------------------------------------
Name | DR. THOMAS DALE REEDER II
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 309-310-1879
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 4867
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------