Provider Demographics
NPI:1750446787
Name:REESE, DAVID ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLAN
Last Name:REESE
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 1:255 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-2536
Mailing Address - Country:US
Mailing Address - Phone:435-881-1666
Mailing Address - Fax:
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2406
Practice Address - Country:US
Practice Address - Phone:435-716-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8029207P00000X
UT4764870-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD3608Medicaid
UT47648701201001OtherBCBS
ID805791400Medicaid
UT47648701201001OtherBCBS
UT005592408Medicare PIN
UT930115879Medicare PIN
UTG08527Medicare UPIN
ID805791400Medicaid