Provider Demographics
NPI:1245335199
Name:REISWIG, JON A (MD,)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:A
Last Name:REISWIG
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 1:11260 N DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7615
Mailing Address - Country:US
Mailing Address - Phone:907-586-3821
Mailing Address - Fax:907-463-2642
Practice Address - Street 1:11260 N DOUGLAS HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7615
Practice Address - Country:US
Practice Address - Phone:907-586-3821
Practice Address - Fax:907-463-2642
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK589207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0589Medicaid
C98345Medicare UPIN
K151872Medicare PIN