Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 42244 | MN |
NPI | 1134152085 |
---|---|
Provider Name | Dr. Robert Joseph Reese |
First Address | Orlando, FL 32886-3550 |
Second Address | Edina, MN 55435-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1701525 | MEDICA PROVIDER NUMBER (01) | MN |
334600500 | (05) | MN |
53M96RE | BCBSMN GRP NUMBER (01) | MN |
53M97RE | BCBS INDIV PROV NUMBER (01) | MN |
F60835 | (02) |