Provider Demographics
NPI:1841260163
Name:REECK, LELAND K (MD)
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:K
Last Name:REECK
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 1:2051 EVERGREEN LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7928
Mailing Address - Country:US
Mailing Address - Phone:928-537-2200
Mailing Address - Fax:928-537-2204
Practice Address - Street 1:2051 EVERGREEN LN
Practice Address - Street 2:SUITE D
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7928
Practice Address - Country:US
Practice Address - Phone:928-537-2200
Practice Address - Fax:928-537-2204
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210089Medicaid
D44386Medicare UPIN
84006Medicare ID - Type Unspecified