Provider Demographics
NPI:1962454355
Name:REECE, RICHARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:REECE
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 1:2503 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-5062
Mailing Address - Country:US
Mailing Address - Phone:423-542-5016
Mailing Address - Fax:423-542-0580
Practice Address - Street 1:SIDNEY & LAMONT STREETS
Practice Address - Street 2:V. A. MEDICAL CENTER
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000011057174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB00075Medicare UPIN