Provider Demographics
NPI:1346202694
Name:REIBER, NICHOLAS E (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:E
Last Name:REIBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93613-2130
Mailing Address - Country:US
Mailing Address - Phone:559-326-2815
Mailing Address - Fax:559-326-2801
Practice Address - Street 1:115 MALL DR
Practice Address - Street 2:AMCH PATHOLOGY DEPT.
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5786
Practice Address - Country:US
Practice Address - Phone:559-537-1380
Practice Address - Fax:559-537-1379
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43587207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G545550Medicaid
CA00G545550Medicaid
CA00G5435870Medicare ID - Type UnspecifiedPPIN