Provider Demographics
NPI:1134398829
Name:SEAN REEDER D.O. P.C
Entity type:Organization
Organization Name:SEAN REEDER D.O. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-867-2219
Mailing Address - Street 1:3811 E BELL RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2138
Mailing Address - Country:US
Mailing Address - Phone:602-867-2219
Mailing Address - Fax:602-867-1637
Practice Address - Street 1:3811 E BELL RD
Practice Address - Street 2:SUITE 312
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2138
Practice Address - Country:US
Practice Address - Phone:602-867-2219
Practice Address - Fax:602-867-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1437115599OtherINDIVIDUAL NPI
AZ1437115599OtherINDIVIDUAL NPI
AZZ65762Medicare PIN