Basic Information
| Provider Information | |||||||||
| NPI: | 1972549020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REESE | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 458 | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726020458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707412299 | ||||||||
| FaxNumber: | 8707416412 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 E CRANDALL | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726013628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707412299 | ||||||||
| FaxNumber: | 8707416412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 09/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C4853 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101287001 | 05 | AR | MEDICAID | 138860000 | 01 | AR | QUALCHOICE | OTHER |