Provider Demographics
NPI:1477937779
Name:REEDER, DAVID JEFFERSON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JEFFERSON
Last Name:REEDER
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 1:333 CITY BLVD W STE 400
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2994
Mailing Address - Country:US
Mailing Address - Phone:714-456-3870
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DRIVE
Practice Address - Street 2:PAVILLION 1, 2ND FLOOR
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042103606Medicare UPIN