Provider Demographics
NPI:1013907583
Name:REISS, GEORGE ERWIN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ERWIN
Last Name:REISS
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 1:740 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2524
Mailing Address - Country:US
Mailing Address - Phone:850-785-3232
Mailing Address - Fax:850-747-8648
Practice Address - Street 1:740 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2524
Practice Address - Country:US
Practice Address - Phone:850-785-3232
Practice Address - Fax:850-747-8648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME601111208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12663ZMedicare ID - Type UnspecifiedINDIV PROVIDER NUMBER
FLE10956Medicare UPIN
FL00874Medicare ID - Type UnspecifiedGRP PROVIDER NUMBER