Provider Demographics
NPI:1326203852
Name:REISLER, TOMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAR
Middle Name:
Last Name:REISLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:REISLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11020 RCA CENTER DR STE 2010
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4277
Practice Address - Country:US
Practice Address - Phone:561-258-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148183208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326203852Medicaid
NC19KN2OtherBCBS OF NC
NC1326203852Medicaid