Provider Demographics
NPI:1609021542
Name:REESAL, ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:REESAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1255 W BASELINE RD STE 138B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5821
Mailing Address - Country:US
Mailing Address - Phone:480-820-5422
Mailing Address - Fax:480-775-4938
Practice Address - Street 1:1255 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5820
Practice Address - Country:US
Practice Address - Phone:480-820-5422
Practice Address - Fax:480-775-4938
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2012-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ403482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ40348OtherMEDICAL LICENSE