Provider Demographics
NPI:1457486870
Name:REECE, MILES C III (DO)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:C
Last Name:REECE
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5137
Mailing Address - Country:US
Mailing Address - Phone:573-472-6576
Mailing Address - Fax:573-472-5307
Practice Address - Street 1:112 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5137
Practice Address - Country:US
Practice Address - Phone:573-472-6576
Practice Address - Fax:573-472-5307
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9F54207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E14576Medicare UPIN