Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 24291 | WI |
NPI | 1023077252 |
---|---|
Provider Name | George T Reizner |
First Address | Madison, WI 53713-3474 |
Second Address | Madison, WI 53713-3474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 20/08/2021 |