Basic Information
| Provider Information | |||||||||
| NPI: | 1114907425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REUTER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 16TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 105282 | MO | N | Other Service Providers | Specialist | 2085R0202X | 60509 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 663196 | 01 | CO | MEDICARE | OTHER | 663145 | 01 | CO | MEDICARE | OTHER | 111257117 | 01 | KS | MEDICARE | OTHER | 3234841A | 01 | MO | RAILROAD MEDICARE- INDIV | OTHER | CI2562 | 01 | KS | RAILROAD MEDICARE- GROUP | OTHER | CI3618 | 01 | MO | RAILROAD MEDICARE- GROUP | OTHER | NA1214132 | 01 | NE | MEDICARE | OTHER | 663169 | 01 | CO | MEDICARE | OTHER | NA1215133 | 01 | NE | MEDICARE | OTHER | 3234841B | 01 | KS | RAILROAD MEDICARE- INDIV | OTHER | 663152 | 01 | CO | MEDICARE | OTHER | 663203 | 01 | CO | MEDICARE | OTHER | KA3249108 | 01 | KS | MEDICARE | OTHER | 100159440D | 05 | KS | MEDICAID | 663183 | 01 | CO | MEDICARE | OTHER | NA2517109 | 01 | NE | MEDICARE | OTHER |