Provider Demographics
NPI:1750467213
Name:REITINGER, RUSSELL GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:GEORGE
Last Name:REITINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2030 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3182
Mailing Address - Country:US
Mailing Address - Phone:303-702-5910
Mailing Address - Fax:303-702-5935
Practice Address - Street 1:2030 MOUNTAIN VIEW AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3182
Practice Address - Country:US
Practice Address - Phone:303-702-5910
Practice Address - Fax:303-702-5935
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28154207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01281542Medicaid
E84046Medicare UPIN