1740279579 NPI number — DR. GEORGE W REICHEL M.D.

Table of content: DR. GEORGE W REICHEL M.D. (NPI 1740279579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740279579 NPI number — DR. GEORGE W REICHEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REICHEL
Provider First Name:
GEORGE
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740279579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5869 KC 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNCTION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76849-6403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 HIGHWAY 16 S
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78624-4474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-997-1402
Provider Business Practice Location Address Fax Number:
830-997-0856
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  E3182 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116830404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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