MEDICARE: DOUGLAS M RECKNER 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	363AM0700X	Medical Physician Assistant	50.006082RX	OH

General Provider Information

NPI Number	:	1457908030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS M RECKNER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 HAZELTON ETNA RD SW STE 100
Second Line	:
City	:	ETNA
State	:	OH
Zip	:	43062-9630
Country	:	US
Telephone Number	:	740-927-7665
Fax Number	:

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

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	10/18/2021

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