Provider Demographics
NPI:1396829735
Name:REICHWAGE, BRETT DAVID
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:DAVID
Last Name:REICHWAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:SUITE 422
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-469-0642
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 422
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-469-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108172207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14KA8OtherBCBSFL
FL006123000Medicaid
AL593-08580OtherBCBSAL
FLGE037ZMedicare PIN