Provider Demographics
NPI:1942428636
Name:REIN, LADALE KACEY (MD)
Entity Type:Individual
Prefix:
First Name:LADALE
Middle Name:KACEY
Last Name:REIN
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 1:823 MARLIN ST
Mailing Address - Street 2:
Mailing Address - City:BAYOU VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:77563-2614
Mailing Address - Country:US
Mailing Address - Phone:832-577-2187
Mailing Address - Fax:
Practice Address - Street 1:823 MARLIN ST
Practice Address - Street 2:
Practice Address - City:BAYOU VISTA
Practice Address - State:TX
Practice Address - Zip Code:77563-2614
Practice Address - Country:US
Practice Address - Phone:832-577-2187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760010407OtherEIN
TX760010407OtherEIN
TXI27029Medicare UPIN
TXCG0510Medicare PIN
TX00R518Medicare PIN
TX8J9902Medicare PIN