Provider Demographics
NPI:1326049321
Name:REICKS, GREGORY C (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:REICKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2503 FORESIGHT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-242-2660
Mailing Address - Fax:970-242-4917
Practice Address - Street 1:2570 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1438
Practice Address - Country:US
Practice Address - Phone:970-298-6601
Practice Address - Fax:970-298-6641
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01293422Medicaid
CO080032251OtherRAIL ROAD MEDICARE
COREU8418OtherBLUE CROSS BLUE SHIELD
CO29342OtherMEDICAL LICENSE NUMBER
COE90277Medicare UPIN
CO01293422Medicaid