Provider Demographics
NPI:1710962618
Name:REITAN, JOHN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:REITAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:ANNE
Other - Last Name:REITAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:9410 DRUMMOND LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4999
Mailing Address - Country:US
Mailing Address - Phone:530-758-0758
Mailing Address - Fax:
Practice Address - Street 1:9410 DRUMMOND LN
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4999
Practice Address - Country:US
Practice Address - Phone:530-758-0758
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23662207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine