Provider Demographics
NPI:1982881744
Name:RONALD ALAN REIFSCHNEIDER DPM
Entity Type:Organization
Organization Name:RONALD ALAN REIFSCHNEIDER DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REIFSCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-743-3668
Mailing Address - Street 1:4120 TAMIAMI TRL
Mailing Address - Street 2:SUITE D 2
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9200
Mailing Address - Country:US
Mailing Address - Phone:941-743-3668
Mailing Address - Fax:941-743-0098
Practice Address - Street 1:4120 TAMIAMI TRL
Practice Address - Street 2:SUITE D 2
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9200
Practice Address - Country:US
Practice Address - Phone:941-743-3668
Practice Address - Fax:941-743-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO994261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390088600Medicaid
FL0447330001Medicare NSC
FL390088600Medicaid