Provider Demographics
NPI:1073821807
Name:FRANK P REUTER JR MD PA
Entity Type:Organization
Organization Name:FRANK P REUTER JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:P
Authorized Official - Last Name:REUTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-597-5579
Mailing Address - Street 1:712 S BOIS D ARC AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1503
Mailing Address - Country:US
Mailing Address - Phone:903-597-5579
Mailing Address - Fax:903-597-5722
Practice Address - Street 1:712 S BOIS D ARC AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1503
Practice Address - Country:US
Practice Address - Phone:903-597-5579
Practice Address - Fax:903-597-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4629207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073821807OtherMEDICARE NPI
TX034143001Medicaid
TX1073821807OtherMEDICARE NPI