Provider Demographics
NPI:1326045329
Name:REICHARD, JEFFREY DAWSON (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAWSON
Last Name:REICHARD
Suffix:
Gender:
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-287-3045
Mailing Address - Fax:859-525-8806
Practice Address - Street 1:7388 TURFWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1381
Practice Address - Country:US
Practice Address - Phone:859-287-3045
Practice Address - Fax:859-585-8806
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.075843207RC0000X
IN01091157A207RC0000X
KY36485207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0369213OtherMEDICARE
KY00954003OtherMEDICARE PTAN
KY0562620OtherMEDICARE
OH611300608066OtherCARESOURCE
KY64028780Medicaid
KY0369020OtherMEDICARE
KYP00752846OtherRR MEDICARE PTAN
KYP00922867OtherRAILROAD MEDICARE
OH2216257Medicaid
KY50024708OtherPASSPORT MEDICAID
P00239000OtherRAILROAD MEDICARE
KY0369213Medicare PIN
OHRE4040528Medicare PIN
KY0562620Medicare PIN
OH4040522Medicare PIN
OH611300608066OtherCARESOURCE
H31121Medicare UPIN
OH4040523Medicare PIN
KY0562620OtherMEDICARE
KYP00752846OtherRR MEDICARE PTAN