Provider Demographics
NPI:1033196894
Name:REINKER, DALE L (DO)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:L
Last Name:REINKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E CHERRY ST
Mailing Address - Street 2:P.O. BOX 315
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1520
Mailing Address - Country:US
Mailing Address - Phone:636-528-7722
Mailing Address - Fax:636-528-7744
Practice Address - Street 1:1175 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1520
Practice Address - Country:US
Practice Address - Phone:636-528-7722
Practice Address - Fax:636-528-7744
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242201705Medicaid
MOA10710Medicare ID - Type Unspecified
MO000013611Medicare PIN