Provider Demographics
NPI:1609869759
Name:REINTGEN, DOUGLAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
Last Name:REINTGEN
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 1:1501 S PINELLAS AVE
Mailing Address - Street 2:ST T
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1955
Mailing Address - Country:US
Mailing Address - Phone:727-934-6797
Mailing Address - Fax:727-942-6503
Practice Address - Street 1:1501 S PINELLAS AVE
Practice Address - Street 2:STE T
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1955
Practice Address - Country:US
Practice Address - Phone:727-934-6797
Practice Address - Fax:727-942-6503
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME510782086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046546100Medicaid
FL04535OtherBLUE CROSS BLUE SHIELD
FL046546100Medicaid
FL020020955Medicare PIN
FLD20940Medicare UPIN
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER