Provider Demographics
NPI:1972502417
Name:REISLER, KEITH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAMES
Last Name:REISLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 MIDWAY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6383
Mailing Address - Country:US
Mailing Address - Phone:972-985-9684
Mailing Address - Fax:972-985-0590
Practice Address - Street 1:3108 MIDWAY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6383
Practice Address - Country:US
Practice Address - Phone:972-985-9684
Practice Address - Fax:972-985-0590
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXG8956207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG8956OtherMEDICAL LICENSE
TXB25864Medicare UPIN