Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD41263 | TN |
N | 207RA0401X | Internist - Addiction Medicine | 41263 | TN |
NPI | 1801998810 |
---|---|
Provider Name | Ralph Thomas Reach |
First Address | Johnson City, TN 37604-1417 |
Second Address | Johnson City, TN 37604-1417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B05126 | (02) |