MEDICARE: DR. SUSAN L REESE 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	207Q00000X	Family Medicine Physician	01063152A	IN
2	207Q00000X	Family Medicine Physician	MD163031	OR
3	207Q00000X	Family Medicine Physician	M-12958	ID

General Provider Information

NPI Number	:	1740227875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN L REESE MD

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:	208-381-8738
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 NW 229TH AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5506
Country	:	US
Telephone Number	:	210-396-3545
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/30/2015

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