Provider Demographics
NPI:1467423939
Name:REECER, MARK V (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:V
Last Name:REECER
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 1:5750 COVENTRY LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7166
Mailing Address - Country:US
Mailing Address - Phone:260-436-9337
Mailing Address - Fax:260-436-9626
Practice Address - Street 1:5750 COVENTRY LN
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7166
Practice Address - Country:US
Practice Address - Phone:260-436-9337
Practice Address - Fax:260-436-9626
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039946A208100000X, 2081P2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400040017Medicare PIN
IN4410190001Medicare NSC
INF28035Medicare UPIN
IN215960AMedicare ID - Type Unspecified