Provider Demographics
NPI:1174977508
Name:MACIAS, REUBEN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:REUBEN
Middle Name:ANTHONY
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:245 JOHN DUKE TYLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BRECKINRIDGE SURGICAL SERVICES
Practice Address - Street 2:207 FAIRGROUND RD.
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143
Practice Address - Country:US
Practice Address - Phone:270-580-2256
Practice Address - Fax:270-580-2251
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT2205207X00000X
KY56795207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery