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General NPI Number Information
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NPI Number | 1689075921
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Entity Type | Organization
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Legal Business Name | JOHN K REIS MD PC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 3052 N SNOW CANYON PKWY UNIT 38
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City | ST GEORGE
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State | UT
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Zip | 84770-6162
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Country | US
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Telephone | 801-540-0802
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Fax |
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Provider Business Mailing Address
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Address Line | 3052 N SNOW CANYON PKWY UNIT 38
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City | ST GEORGE
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State | UT
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Zip | 84770-6162
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Country | US
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Telephone | 801-540-0802
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN K REIS SR.
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Credential | M.D.
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Telephone | 801-540-0802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00034551
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License Number State | UT
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