1972561553 NPI number — WARREN LOUIS REUTHER III MD

Table of content: WARREN LOUIS REUTHER III MD (NPI 1972561553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972561553 NPI number — WARREN LOUIS REUTHER III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REUTHER
Provider First Name:
WARREN
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
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:
1972561553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 ANGLERS AVENUE SUITE 24
Provider Second Line Business Mailing Address:
FLORIDA UNITED RADIOLOGY
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-962-6265
Provider Business Mailing Address Fax Number:
954-893-9595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 N 45 STREET
Provider Second Line Business Practice Location Address:
COLUMBIA HOSPITAL
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-863-3970
Provider Business Practice Location Address Fax Number:
561-863-2527
Provider Enumeration Date:
05/03/2006

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: 2085R0202X , with the licence number:  ME88766 , 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: 101591900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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