1326013418 NPI number — ROGER N REEB PHD

Table of content: ROGER N REEB PHD (NPI 1326013418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326013418 NPI number — ROGER N REEB PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEB
Provider First Name:
ROGER
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326013418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 CUSHWA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45459-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-626-6300
Provider Business Mailing Address Fax Number:
937-434-8590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COLLEGE PARK AVE
Provider Second Line Business Practice Location Address:
ST JOSHEPH HALL #306
Provider Business Practice Location Address City Name:
UNIVERSITY OF DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45469-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-626-6300
Provider Business Practice Location Address Fax Number:
937-434-8590
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  5738 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2307855 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com