Individual
BROCK T REICHERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1024 S LEMAY AVE, FORT COLLINS, CO 80524-3929
(970) 495-7000
(303) 306-7753
Mailing address
PO BOX 912215, DENVER, CO 80291-2215
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0005024
CO
363A00000X
Physician Assistant
PA08630
TX
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
325267801
—
TX
Enumeration date
05/31/2013
Last updated
10/04/2017
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