Provider Demographics
NPI:1487629929
Name:RIESZ, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RIESZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAMDEN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2012
Mailing Address - Country:US
Mailing Address - Phone:210-829-0228
Mailing Address - Fax:210-455-0169
Practice Address - Street 1:WILFORD HALL
Practice Address - Street 2:1100 WILFORD HALL LOOP, BLDG 4554, JBSA LACKLAND, TX
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-262-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210038472085R0202X
IL0361538322085R0202X
TXK56772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00141574OtherMEDICARE RAILROAD
TX8B8021Medicare PIN
TXH10858Medicare UPIN