Provider Demographics
NPI:1689075921
Name:JOHN K REIS MD PC
Entity Type:Organization
Organization Name:JOHN K REIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:REIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:801-540-0802
Mailing Address - Street 1:3052 N SNOW CANYON PKWY
Mailing Address - Street 2:UNIT 38
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6162
Mailing Address - Country:US
Mailing Address - Phone:801-540-0802
Mailing Address - Fax:
Practice Address - Street 1:3052 N SNOW CANYON PKWY
Practice Address - Street 2:UNIT 38
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6162
Practice Address - Country:US
Practice Address - Phone:801-540-0802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00034551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty