Provider Demographics
NPI:1861874968
Name:ROBERTS, REECE (RPSGT)
Entity type:Individual
Prefix:
First Name:REECE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22486 MICHIGAN TRL
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1633
Mailing Address - Country:US
Mailing Address - Phone:660-349-7647
Mailing Address - Fax:
Practice Address - Street 1:22486 MICHIGAN TRL
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1633
Practice Address - Country:US
Practice Address - Phone:660-349-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other