Provider Demographics
NPI:1033199344
Name:REES, JOHN HERBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HERBERT
Last Name:REES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 WILD HORSE CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-9610
Mailing Address - Country:US
Mailing Address - Phone:571-220-0165
Mailing Address - Fax:
Practice Address - Street 1:7103 WILD HORSE CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-9610
Practice Address - Country:US
Practice Address - Phone:571-220-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00478942085N0700X, 2085R0202X
FLME738612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD965401100Medicaid
FL021574800Medicaid
42226TOtherMEDICARE PTAN
MI104520401Medicaid
42226TOtherMEDICARE PTAN
OH4097802Medicare PIN
FL021574800Medicaid
DE011163M06Medicare PIN
MD192MD061Medicare PIN
FL42226ZMedicare UPIN
OH4097801Medicare PIN
MD193MD182Medicare PIN
MD965401100Medicaid
TX8A9486Medicare PIN
MI104520401Medicaid
MD193MD182Medicare PIN
MD965401100Medicaid
TX8A9486Medicare PIN
TX47856202Medicaid
WV2005354000Medicaid
MI104520401Medicaid
FL004958600Medicaid