Provider Demographics
NPI:1568812477
Name:REITER, PAYTON (MD)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:REITER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 MAXWELL LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6639
Mailing Address - Country:US
Mailing Address - Phone:737-235-8024
Mailing Address - Fax:737-201-2696
Practice Address - Street 1:2308 MAXWELL LN UNIT 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6639
Practice Address - Country:US
Practice Address - Phone:737-235-8024
Practice Address - Fax:737-201-2696
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6721207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine