Provider Demographics
NPI:1568401313
Name:REINHARDT, JERALD W (MD)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:W
Last Name:REINHARDT
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 1:212 PLAIN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7942
Mailing Address - Country:US
Mailing Address - Phone:701-772-0412
Mailing Address - Fax:
Practice Address - Street 1:1428 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1605
Practice Address - Country:US
Practice Address - Phone:866-773-1390
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29094207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D26237Medicare UPIN