Provider Demographics
NPI:1699009118
Name:RIEMAN, CHRISTOPHER GENE (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GENE
Last Name:RIEMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:232-343-9960
Mailing Address - Fax:239-343-9977
Practice Address - Street 1:8380 RIVERWALK PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8758
Practice Address - Country:US
Practice Address - Phone:239-343-9960
Practice Address - Fax:239-343-9977
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106680363A00000X, 363AM0700X
WAPA60115659363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2158989OtherCIGNA
FLP1015361OtherFREEDOM
FL5751998OtherAETNA
FLP01318692OtherRR MEDICARE
FL398635OtherAVMED
FL716610OtherWELLCARE
FLP954204OtherOPTIMUM
FLYOC73OtherBCBS OF FL
FL006666500Medicaid