Provider Demographics
NPI:1730173964
Name:REBER, RICHARD G (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:REBER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 802758
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0001
Mailing Address - Country:US
Mailing Address - Phone:314-645-4900
Mailing Address - Fax:314-645-6548
Practice Address - Street 1:1500 N OAKLAND AVE
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3011
Practice Address - Country:US
Practice Address - Phone:417-328-6446
Practice Address - Fax:417-328-6369
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1037082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
16-02601OtherUNITED HEALTHCARE
16-02601OtherUNITED HEALTHCARE