Provider Demographics
NPI:1861594590
Name:REINKING, JUDY RAE (DPM)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:RAE
Last Name:REINKING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-1822
Mailing Address - Country:US
Mailing Address - Phone:515-295-9644
Mailing Address - Fax:515-295-9644
Practice Address - Street 1:1318 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-1822
Practice Address - Country:US
Practice Address - Phone:515-295-9644
Practice Address - Fax:515-295-9644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA509213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0018127Medicaid
IA0018127Medicaid
IAIB1156001Medicare PIN
IA01812Medicare ID - Type Unspecified
IAU09709Medicare UPIN