Provider Demographics
NPI:1972549020
Name:REESE, RONALD R (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:R
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:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-0458
Mailing Address - Country:US
Mailing Address - Phone:870-741-2299
Mailing Address - Fax:870-741-6412
Practice Address - Street 1:114 E CRANDALL
Practice Address - Street 2:SUITE C
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3628
Practice Address - Country:US
Practice Address - Phone:870-741-2299
Practice Address - Fax:870-741-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101287001Medicaid
AR138860000OtherQUALCHOICE
AR138860000OtherQUALCHOICE
ARD17061Medicare UPIN