Provider Demographics
NPI:1114981941
Name:ERIC P REINTSEMA MD PA
Entity Type:Organization
Organization Name:ERIC P REINTSEMA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:REINTSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-423-1111
Mailing Address - Street 1:14876 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2701
Mailing Address - Country:US
Mailing Address - Phone:941-423-1111
Mailing Address - Fax:941-423-2274
Practice Address - Street 1:14876 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2701
Practice Address - Country:US
Practice Address - Phone:941-423-1111
Practice Address - Fax:941-423-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF7209OtherRR MCR
FL=========OtherTAX ID
FL=========OtherTAX ID