Basic Information
Provider Information
NPI: 1477684405
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REICHERT
FirstName: MATTHEW
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 94670
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731434670
CountryCode: US
TelephoneNumber: 4056823303
FaxNumber: 4053846793
Practice Location
Address1: 10904 KINGSTON PIKE STE 103
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379342953
CountryCode: US
TelephoneNumber: 8655888831
FaxNumber: 8685888841
Other Information
ProviderEnumerationDate: 03/09/2007
LastUpdateDate: 05/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X43458TNN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0200X43458TNN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RS0012X43458TNN Allopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
207RP1001X43458TNY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


Home