Provider Demographics
NPI:1063472579
Name:REULAND, KURT STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:STEPHEN
Last Name:REULAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 910
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1915
Mailing Address - Country:US
Mailing Address - Phone:903-705-0072
Mailing Address - Fax:903-705-0068
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 910
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1915
Practice Address - Country:US
Practice Address - Phone:903-705-0072
Practice Address - Fax:903-705-0068
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ44732085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129588301Medicaid
TX129588301Medicaid