Provider Demographics
NPI:1790832756
Name:RECK, SAMUEL J (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:RECK
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 1:2900 12TH AVE N STE 265W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7501
Mailing Address - Country:US
Mailing Address - Phone:406-237-7999
Mailing Address - Fax:
Practice Address - Street 1:2900 12TH AVE N STE 265W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7501
Practice Address - Country:US
Practice Address - Phone:406-237-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11304207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000098456OtherBCBS PIN
WY123851500OtherMDCD PIN
MT0115753OtherMDCD PIN
MT011000117Medicare PIN
MT0115753OtherMDCD PIN
MTP00415957Medicare PIN
MT011000116Medicare PIN