Provider Demographics
NPI:1336740505
Name:REECE, BENJAMIN H (PA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:H
Last Name:REECE
Suffix:
Gender:M
Credentials:PA
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 340
Mailing Address - Street 2:
Mailing Address - City:NATURITA
Mailing Address - State:CO
Mailing Address - Zip Code:81422-0340
Mailing Address - Country:US
Mailing Address - Phone:970-865-2665
Mailing Address - Fax:970-865-2764
Practice Address - Street 1:421 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NATURITA
Practice Address - State:CO
Practice Address - Zip Code:81422-5018
Practice Address - Country:US
Practice Address - Phone:970-865-2665
Practice Address - Fax:970-865-2674
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COPA.0006639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program