Provider Demographics
NPI:1750394227
Name:REESE, DREW AUBREY (DO)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:AUBREY
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 1:14800 W MOUNTAIN VIEW BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2700
Mailing Address - Country:US
Mailing Address - Phone:623-584-3376
Mailing Address - Fax:623-584-3375
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2700
Practice Address - Country:US
Practice Address - Phone:623-584-3376
Practice Address - Fax:623-584-3375
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1070207N00000X
ORDO150367207N00000X
WAOP60762580207N00000X
AZ008872207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ086313Medicaid