Provider Demographics
NPI:1134152085
Name:REESE, ROBERT JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:REESE
Suffix:
Gender:M
Credentials:DO
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 863550
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3550
Mailing Address - Country:US
Mailing Address - Phone:803-808-8070
Mailing Address - Fax:803-808-8074
Practice Address - Street 1:6525 FRANCE AVE S
Practice Address - Street 2:SUITE
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2148
Practice Address - Country:US
Practice Address - Phone:803-808-8070
Practice Address - Fax:803-808-8074
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN422442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN334600500Medicaid
MN53M97REOtherBCBS INDIV PROV NUMBER
MN1701525OtherMEDICA PROVIDER NUMBER
MN53M96REOtherBCBSMN GRP NUMBER
MN334600500Medicaid
F60835Medicare UPIN
MN53M96REOtherBCBSMN GRP NUMBER