Provider Demographics
NPI:1063400760
Name:REIFF, PATRICIA R (MD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:R
Last Name:REIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:RUTH
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1101 WEST MC DOWELL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007
Mailing Address - Country:US
Mailing Address - Phone:602-252-8089
Mailing Address - Fax:602-252-8460
Practice Address - Street 1:1101 WEST MC DOWELL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007
Practice Address - Country:US
Practice Address - Phone:602-252-8089
Practice Address - Fax:602-252-8460
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17334207Q00000X
AZAZ17334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ292459Medicaid
AZZMD17334AMedicare ID - Type Unspecified
E28396Medicare UPIN