Provider Demographics
NPI:1124226378
Name:D PETER REEDY MD PA
Entity Type:Organization
Organization Name:D PETER REEDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-367-7502
Mailing Address - Street 1:999 N CURTIS RD
Mailing Address - Street 2:307
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1336
Mailing Address - Country:US
Mailing Address - Phone:208-367-7500
Mailing Address - Fax:208-367-7506
Practice Address - Street 1:999 N CURTIS RD
Practice Address - Street 2:307
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1336
Practice Address - Country:US
Practice Address - Phone:208-367-7500
Practice Address - Fax:208-367-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-5296207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1375981Medicare PIN
IDC36983Medicare UPIN