Provider Demographics
NPI:1023192721
Name:REYZELMAN, ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:REYZELMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3709
Mailing Address - Country:US
Mailing Address - Phone:415-292-0638
Mailing Address - Fax:415-292-0718
Practice Address - Street 1:2299 POST ST
Practice Address - Street 2:STE 205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3443
Practice Address - Country:US
Practice Address - Phone:415-292-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4136213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41360Medicaid
CA000E41360Medicare ID - Type Unspecified
CA000E41360Medicaid