MEDICARE: KEITH R REBER DPM

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	213E00000X	Podiatrist	103861-0501	UT
2	213ES0103X	Foot & Ankle Surgery Podiatrist	103861-0501	UT

General Provider Information

NPI Number	:	1669479358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH R REBER DPM

Provider Business Mailing Address
First Line	:	754 S MAIN ST
Second Line	:	SUITE 3
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5504
Country	:	US
Telephone Number	:	435-628-2671
Fax Number	:	435-634-1601

Provider Business Practice Location Address
First Line	:	754 S MAIN ST
Second Line	:	SUITE 3
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5504
Country	:	US
Telephone Number	:	435-628-2671
Fax Number	:	435-634-1601

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/13/2014

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Directions to “ KEITH R REBER DPM” Practice Location

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