Provider Demographics
NPI:1427085281
Name:VERNER, REESE A (MD)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:A
Last Name:VERNER
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 1:3399 E LOUISE DR
Mailing Address - Street 2:#400
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5047
Mailing Address - Country:US
Mailing Address - Phone:208-364-3000
Mailing Address - Fax:
Practice Address - Street 1:3399 E. LOUISE DR.
Practice Address - Street 2:#400
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-364-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805208300Medicaid
IDM7481OtherSTATE LICENSE #
G77853Medicare UPIN
ID20000893Medicare PIN
ID805208300Medicaid