Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 9901000 | NC |
NPI | 1174597389 |
---|---|
Provider Name | Dr. Derek Lawrence Reinke |
First Address | Morrisville, NC 27560-8442 |
Second Address | Cary, NC 27511-7413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 09/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1217R | BCBS (01) | |
1822991 | UNITED HEALTHCARE (01) | |
2075594 | FIRST HEALTH (01) | |
2350603 | AETNA HMO (01) | |
5544751 | AETNA PPO (01) | |
891217R | (05) | NC |
G74026 | (02) |