Provider Demographics
NPI:1336161835
Name:REITER, JOEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:REITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1103 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4805
Mailing Address - Country:US
Mailing Address - Phone:707-528-0397
Mailing Address - Fax:707-528-1086
Practice Address - Street 1:1103 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4805
Practice Address - Country:US
Practice Address - Phone:707-528-0397
Practice Address - Fax:707-528-1086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG174912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A40094Medicare UPIN