Provider Demographics
NPI:1356441851
Name:REEDER, STEPHEN M (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:REEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E. WALNUT LAWN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-269-4450
Mailing Address - Fax:417-269-8333
Practice Address - Street 1:960 E. WALNUT LAWN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-4450
Practice Address - Fax:417-269-8333
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3M98207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
19679OtherBLUE CROSS OF MO
MO202825204Medicaid
E57280Medicare UPIN
19679OtherBLUE CROSS OF MO
P00371912Medicare PIN
962535144Medicare PIN
110045638Medicare PIN