Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 12238 | ND |
N | 2086S0129X | Vascular Surgeon | 51249 | MN |
N | 2086S0129X | Vascular Surgeon | A64977 | CA |
NPI | 1154355311 |
---|---|
Provider Name | Todd Reil |
First Address | Fargo, ND 58102-3641 |
Second Address | Fargo, ND 58102-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 21/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17004 | (05) | ND |