MEDICARE: REECE CHRISTOPHERSON MARTIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA-1282	AR

General Provider Information

NPI Number	:	1194421339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REECE CHRISTOPHERSON MARTIN PA-C

Provider Business Mailing Address
First Line	:	242 N SOLITUDE BND
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-4007
Country	:	US
Telephone Number	:	913-269-0979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 S RIFE MEDICAL LN
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1452
Country	:	US
Telephone Number	:	479-338-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	06/03/2026

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