Provider Demographics
NPI:1669784351
Name:THOMAS D. REEDER II, D.O., P.C.
Entity type:Organization
Organization Name:THOMAS D. REEDER II, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:309-310-1879
Mailing Address - Street 1:2212 NW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8848
Mailing Address - Country:US
Mailing Address - Phone:405-608-0894
Mailing Address - Fax:405-608-0873
Practice Address - Street 1:2212 NW 47TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8848
Practice Address - Country:US
Practice Address - Phone:405-608-0894
Practice Address - Fax:405-608-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4867207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty