Provider Demographics
NPI:1851382402
Name:REISER, JOCHEN (MD ,PHD)
Entity Type:Individual
Prefix:DR
First Name:JOCHEN
Middle Name:
Last Name:REISER
Suffix:
Gender:M
Credentials:MD ,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NW 12 AVE
Mailing Address - Street 2:JMT EAST 1007
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1028
Mailing Address - Country:US
Mailing Address - Phone:305-243-4606
Mailing Address - Fax:305-243-3506
Practice Address - Street 1:1580 NW 10TH AVE
Practice Address - Street 2:BATCH 633A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1013
Practice Address - Country:US
Practice Address - Phone:305-243-2349
Practice Address - Fax:305-243-3506
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224081207R00000X, 207RN0300X
FLME103154207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468479OtherTUFTS HEALTH PLAN
FL001279400Medicaid
MAJ28718OtherBCBS MA
MAA38716Medicare ID - Type Unspecified
MA468479OtherTUFTS HEALTH PLAN