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General NPI Number Information
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NPI Number | 1912294661
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Entity Type | Individual
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Provider Name | REGINALD FEARS MD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1947 N FOUNDERS CIR
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City | WICHITA
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State | KS
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Zip | 67206-3548
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Country | US
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Telephone | 316-613-4670
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8035
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City | WICHITA
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State | KS
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Zip | 67208-0035
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Country | US
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Telephone | 316-689-9135
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 04-38273
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036.167047
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 01088276A
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License Number State | IN
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