Basic Information
Provider Information
NPI: 1083607634
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REECE
FirstName: JULIANNA
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MARTINEZ
OtherFirstName: JULIANNA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 810 E 3RD ST
Address2: SUITE 201
City: DURANGO
State: CO
PostalCode: 813015728
CountryCode: US
TelephoneNumber: 9707641790
FaxNumber: 9703757927
Practice Location
Address1: 810 E 3RD ST
Address2: SUITE 201
City: DURANGO
State: CO
PostalCode: 813015728
CountryCode: US
TelephoneNumber: 9707641790
FaxNumber: 9703757927
Other Information
ProviderEnumerationDate: 08/30/2005
LastUpdateDate: 01/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X55863COY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XA81004CAN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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