Provider Demographics
NPI:1093839870
Name:KEITH J REISLER MD, PA
Entity Type:Organization
Organization Name:KEITH J REISLER MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:REISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-985-9684
Mailing Address - Street 1:3108 MIDWAY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6383
Mailing Address - Country:US
Mailing Address - Phone:972-985-9684
Mailing Address - Fax:972-985-0590
Practice Address - Street 1:3108 MIDWAY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6383
Practice Address - Country:US
Practice Address - Phone:972-985-9684
Practice Address - Fax:972-985-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0009BMMedicare ID - Type Unspecified