Provider Demographics
NPI:1235358243
Name:GARY L REASOR, MD P.S.C
Entity Type:Organization
Organization Name:GARY L REASOR, MD P.S.C
Other - Org Name:METRO PAIN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REASOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-896-9877
Mailing Address - Street 1:400 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4204
Mailing Address - Country:US
Mailing Address - Phone:502-896-9877
Mailing Address - Fax:502-896-9972
Practice Address - Street 1:400 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4204
Practice Address - Country:US
Practice Address - Phone:502-896-9877
Practice Address - Fax:502-896-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1316610001Medicare NSC
KY9620Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER