Provider Demographics
NPI:1659470896
Name:REISTER, GENE G (DPM)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:G
Last Name:REISTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N COLLINS BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2636
Mailing Address - Country:US
Mailing Address - Phone:972-690-5374
Mailing Address - Fax:972-690-6446
Practice Address - Street 1:2001 N COLLINS BLVD
Practice Address - Street 2:STE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2636
Practice Address - Country:US
Practice Address - Phone:972-690-5374
Practice Address - Fax:972-690-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDP1436213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018663701Medicaid
TX00EH98Medicare PIN
TX8F21949Medicare PIN
TXT15497Medicare UPIN
TX018663701Medicaid