Provider Demographics
NPI:1437115599
Name:REEDER, SEAN C (DO)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:C
Last Name:REEDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3933 E EDNA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2127
Mailing Address - Country:US
Mailing Address - Phone:602-867-2219
Mailing Address - Fax:602-867-1637
Practice Address - Street 1:3933 E EDNA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2127
Practice Address - Country:US
Practice Address - Phone:602-867-2219
Practice Address - Fax:602-867-1637
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-1028644OtherTIN
AZ86-1028644OtherTIN
AZH38075Medicare UPIN