Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD.202441 | LA |
N | 2080P0210X | Pediatric Nephrologist | 202441 | LA |
N | 2080P0210X | Pediatric Nephrologist | MA62698 | NJ |
N | 2080P0210X | Pediatric Nephrologist | MD.202441 | LA |
NPI | 1467537357 |
---|---|
Provider Name | Dr. Lewis Reisman |
First Address | Shreveport, LA 71103 |
Second Address | Shreveport, LA 71103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 12/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1330698 | (05) | LA |
6911307 | (05) | NJ |
B78246 | (02) |