Provider Demographics
NPI:1972575819
Name:REILAND, ANDREW WILLCOX (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLCOX
Last Name:REILAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-2022
Mailing Address - Country:US
Mailing Address - Phone:256-538-7273
Mailing Address - Fax:256-538-2514
Practice Address - Street 1:515 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-2022
Practice Address - Country:US
Practice Address - Phone:256-538-7273
Practice Address - Fax:256-538-2514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA67223Medicare UPIN
AL81362Medicare ID - Type Unspecified
AL19664Medicare ID - Type Unspecified