Provider Demographics
NPI:1639156177
Name:REITTER, DAVID R (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:REITTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:410 BENEDICTA AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2005
Mailing Address - Country:US
Mailing Address - Phone:719-846-9213
Mailing Address - Fax:719-846-2752
Practice Address - Street 1:410 BENEDICTA AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2005
Practice Address - Country:US
Practice Address - Phone:719-846-9213
Practice Address - Fax:719-846-2752
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.50480208600000X
MN44809208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN091094500Medicaid
MNH20966Medicare UPIN
MN020001838Medicare ID - Type Unspecified