Provider Demographics
NPI:1063449635
Name:REISTER, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:REISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-789-2663
Mailing Address - Fax:303-788-4871
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-789-2663
Practice Address - Fax:303-788-4871
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
CO36001207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY129802000Medicaid
NE1245556091Medicaid
KS200550830BMedicaid
CO01360015Medicaid
NE1245556091Medicaid
CO264075YMCJMedicare PIN
WY129802000Medicaid