Provider Demographics
NPI:1568932267
Name:REISCH, CHRISTIAN DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:DAVID
Last Name:REISCH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4314 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-4130
Mailing Address - Country:US
Mailing Address - Phone:214-500-2829
Mailing Address - Fax:
Practice Address - Street 1:1280 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7509
Practice Address - Country:US
Practice Address - Phone:817-310-0898
Practice Address - Fax:817-310-5524
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2019-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA12555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant