Provider Demographics
NPI:1619927969
Name:REISS, GEORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:REISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:BLDG F STE 101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3709
Mailing Address - Country:US
Mailing Address - Phone:623-878-3939
Mailing Address - Fax:
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:STE F101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-878-3939
Practice Address - Fax:623-878-5567
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-06-03
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Provider Licenses
StateLicense IDTaxonomies
AZ16811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ279241Medicaid
AZMD16811Medicare PIN
AZC65865Medicare UPIN