MEDICARE: MR. DAVID KEVIN REYBURN MD

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	208000000X	Pediatrics Physician	01042178	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346242294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID KEVIN REYBURN MD

Provider Business Mailing Address
First Line	:	710 N STATE ROAD 25
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-9785
Country	:	US
Telephone Number	:	574-223-8080
Fax Number	:	574-223-8078

Provider Business Practice Location Address
First Line	:	1400 E 9TH ST
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-8931
Country	:	US
Telephone Number	:	574-223-2020
Fax Number	:	574-223-5847

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	05/10/2013

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Directions to “ MR. DAVID KEVIN REYBURN MD” Practice Location

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