Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 12221 | NH |
N | 207QS0010X | Family Doctor - Sports Medicine | 12221 | NH |
NPI | 1205899556 |
---|---|
Provider Name | Mark L Reeder |
First Address | Exeter, NH 03833-2997 |
Second Address | Kingston, NH 03848-3072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 23/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3078051 | (05) | NH |
F40629 | (02) |