Provider Demographics
NPI:1669457560
Name:REINNINGER, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:REINNINGER
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 1:103 UNIVERSITY PL
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-6809
Mailing Address - Country:US
Mailing Address - Phone:337-457-2252
Mailing Address - Fax:337-457-2252
Practice Address - Street 1:103 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-6809
Practice Address - Country:US
Practice Address - Phone:337-457-2252
Practice Address - Fax:337-457-2252
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0077522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1040622Medicaid
LA379138ZLACMedicare PIN