Provider Demographics
NPI:1942312129
Name:REESER, GARY LEE (LMT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:REESER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N LOCKWOOD RIDGE RD
Mailing Address - Street 2:UNIT 113
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-6536
Mailing Address - Country:US
Mailing Address - Phone:941-266-9859
Mailing Address - Fax:
Practice Address - Street 1:4223 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2564
Practice Address - Country:US
Practice Address - Phone:941-266-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 42688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC4022OtherBCBS