1619926227 NPI number — DR. TERENCE N REISMAN M. D.

Table of content: DR. TERENCE N REISMAN M. D. (NPI 1619926227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619926227 NPI number — DR. TERENCE N REISMAN M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REISMAN
Provider First Name:
TERENCE
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619926227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MICCOSUKEE RD
Provider Second Line Business Mailing Address:
FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-5314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-431-7900
Provider Business Mailing Address Fax Number:
850-431-7990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MICCOSUKEE RD
Provider Second Line Business Practice Location Address:
FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-5314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-431-7900
Provider Business Practice Location Address Fax Number:
850-431-7990
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME 15393 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME15393 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 37199X . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 055323900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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