1417131426 NPI number — BRIAN REASONER NP

Table of content: BRIAN REASONER NP (NPI 1417131426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417131426 NPI number — BRIAN REASONER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REASONER
Provider First Name:
BRIAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1417131426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 N. THUNDERBIRD CIRCLE
Provider Second Line Business Mailing Address:
NEXTCARE URGENT CARE
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85215-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-353-2235
Provider Business Mailing Address Fax Number:
480-776-0025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5369 S. CALLE SANTA CRUZ
Provider Second Line Business Practice Location Address:
SUITE 145 NEXTCARE URGENT CARE
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-573-7500
Provider Business Practice Location Address Fax Number:
480-776-0025
Provider Enumeration Date:
12/27/2007

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: 363LF0000X , with the licence number:  AP30007918 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 633076 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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