Provider Demographics
NPI:1760470066
Name:REISS, DANA L (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:REISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 HUEBNER ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1334
Mailing Address - Country:US
Mailing Address - Phone:210-614-3370
Mailing Address - Fax:210-614-6859
Practice Address - Street 1:9150 HUEBNER ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1334
Practice Address - Country:US
Practice Address - Phone:210-614-3370
Practice Address - Fax:210-614-6859
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81582XOtherBLUE CROSS BLUE SHIELD
TX47479301Medicaid
TX89412KMedicare ID - Type Unspecified
TX47479301Medicaid