Provider Demographics
NPI:1669033254
Name:REITZ, JOSHUA ALAN (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALAN
Last Name:REITZ
Suffix:
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 1:333 NORTH 300 WEST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3098
Mailing Address - Country:US
Mailing Address - Phone:303-436-2713
Mailing Address - Fax:801-463-7341
Practice Address - Street 1:1000 EAST 100 NORTH
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-3098
Practice Address - Country:US
Practice Address - Phone:801-465-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT019562207P00000X
UT13339684-1204207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine