Provider Demographics
NPI:1376668012
Name:REITER, BRADEN JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:JAMES
Last Name:REITER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:68 SCHOOL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443
Mailing Address - Country:US
Mailing Address - Phone:970-668-2510
Mailing Address - Fax:970-668-2511
Practice Address - Street 1:68 SCHOOL RD
Practice Address - Street 2:STE 200
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-2510
Practice Address - Fax:970-668-2511
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28258207Q00000X
KS05-45894207Q00000X
NY1799392083X0100X
CODR.0028258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000194578Medicaid
COCOB4545Medicare PIN