Provider Demographics
NPI:1285071381
Name:REESER, BENJAMIN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LEE
Last Name:REESER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W RIORDAN RD STE 100-132
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0842
Mailing Address - Country:US
Mailing Address - Phone:623-396-5623
Mailing Address - Fax:
Practice Address - Street 1:7160 E KIERLAND BLVD APT 213
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2988
Practice Address - Country:US
Practice Address - Phone:480-418-6985
Practice Address - Fax:480-546-3144
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52054207P00000X, 207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ257365Medicaid