Individual provider · NPI-1
Dr. Matthew C Reeck, MD
Dermatology · Ketchum, ID
NPI number1124022801
StatusActive
Last updated in NPPESFeb 5, 2014
Details
- NPI
- 1124022801
- Entity type
- Individual (NPI-1)
- Name
- Dr. Matthew C Reeck
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 9, 2005
- Last updated
- Feb 5, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | M11887 | ID | Yes |
| 207N00000X | Dermatology | 01054306a | IN |
Practice location
191 W 5th StKetchum, ID 83340-0000
Phone 208-725-2171
Mailing address
190 E Bannock StBoise, ID 83712-6241
Phone 208-381-2222 · Fax 812-331-0196
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