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General NPI Number Information
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NPI Number | 1912345901
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Entity Type | Organization
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Legal Business Name | PREMIER PLASTIC SURGERY AND DERMATOLOGY ASSOCIATES, LTD
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 6728 LOOP RD BLDG. 5, SUITE 301
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City | CENTERVILLE
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State | OH
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Zip | 45459-2196
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Country | US
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Telephone | 937-438-5333
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Fax | 937-438-0160
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Provider Business Mailing Address
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Address Line | 6728 LOOP RD BLDG. 5, SUITE 301
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City | CENTERVILLE
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State | OH
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Zip | 45459-2196
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Country | US
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Telephone | 937-438-5333
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Fax | 937-438-0160
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. CHRISTOPHER A REEDER
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Credential | D.O.
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Telephone | 937-438-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 34005419
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License Number State | OH
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