Provider Demographics
NPI:1457356263
Name:REASOR, GARY LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LLOYD
Last Name:REASOR
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 1:400 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4204
Mailing Address - Country:US
Mailing Address - Phone:502-896-9877
Mailing Address - Fax:502-896-9972
Practice Address - Street 1:400 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4204
Practice Address - Country:US
Practice Address - Phone:502-896-9877
Practice Address - Fax:502-896-9972
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26758208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000360623OtherANTHEM
KY64267586Medicaid
KY0962001Medicare ID - Type Unspecified
KY64267586Medicaid