Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME601111 | FL |
Y | 208600000X | Surgeon | ME601111 | FL |
NPI | 1013907583 |
---|---|
Provider Name | George Erwin Reiss |
First Address | Panama City, FL 32401-2524 |
Second Address | Panama City, FL 32401-2524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E10956 | (02) | FL |