Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 04-19247 | KS |
N | 2081P2900X | Pain Medicine | 04-19247 | KS |
N | 2081S0010X | Sports Medicine | 04-19247 | KS |
N | 213ES0000X | Sports Medicine | 04-19247 | KS |
NPI | 1508958679 |
---|---|
Provider Name | Kenneth Dean Reeves |
First Address | Shawnee Mission, KS 66205-1348 |
Second Address | Shawnee Mission, KS 66205-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100198030A | (05) | KS |
D16865 | (02) | KS |