Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G42150 | CA |
N | 207NS0135X | Procedural Dermatology | G42150 | CA |
N | 207P00000X | Emergency Physician | G42150 | CA |
Y | 207R00000X | Internist | G42150 | CA |
Y | 111NI0900X | Internist | G42150 | CA |
N | 207RA0401X | Internist - Addiction Medicine | G42150 | CA |
N | 207RH0002X | Hospice and Palliative Medicine | G42150 | CA |
N | 208D00000X | General Practice Physician | G42150 | CA |
NPI | 1780641712 |
---|---|
Provider Name | Dr. Scott D Reiter |
First Address | Santa Monica, CA 90405-5735 |
Second Address | Santa Monica, CA 90405-5735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 24/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G421500 | (05) | CA |
A48839 | (02) | |
XR9324308 | SAMHSA DATA WAIVER (01) | CA |