Provider Demographics
NPI:1801845458
Name:REISS, JASON ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ERIC
Last Name:REISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1641 TAMIAMI TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1042
Mailing Address - Country:US
Mailing Address - Phone:941-629-6262
Mailing Address - Fax:941-629-1782
Practice Address - Street 1:1641 TAMIAMI TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1042
Practice Address - Country:US
Practice Address - Phone:941-629-6262
Practice Address - Fax:941-629-1782
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9617207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00988963OtherRAILROAD MEDICARE
FL41787OtherBC/BS OF FL
FL$$$$$$$$$OtherTRICARE
FL0873960001Medicare NSC
FL41787YMedicare PIN
FL591563145OtherCIGNA
FL41787YMedicare PIN
FL$$$$$$$$$OtherTRICARE
FL13932OtherUNIVERSAL
FL41787OtherBC/BS OF FL
FLI53092Medicare UPIN