Provider Demographics
NPI:1609033950
Name:REIS, JOHN W (MS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:REIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:724 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2929
Mailing Address - Country:US
Mailing Address - Phone:515-432-8534
Mailing Address - Fax:515-432-8631
Practice Address - Street 1:724 ALLEN ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-2929
Practice Address - Country:US
Practice Address - Phone:515-432-8534
Practice Address - Fax:515-432-8631
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00279237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27059Medicare PIN