Provider Demographics
NPI:1033471115
Name:JUSTIN RECKARD MD INC
Entity Type:Organization
Organization Name:JUSTIN RECKARD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-776-7600
Mailing Address - Street 1:71943 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4848
Mailing Address - Country:US
Mailing Address - Phone:760-776-7600
Mailing Address - Fax:760-776-7640
Practice Address - Street 1:71943 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4848
Practice Address - Country:US
Practice Address - Phone:760-776-7600
Practice Address - Fax:760-776-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120374208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty