MEDICARE: DR. SCOTT D REITER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G42150	CA
2	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	G42150	CA
3	208D00000X	General Practice Physician	G42150	CA
4	207R00000X	Internal Medicine Physician	G42150	CA
5	207RA0401X	Addiction Medicine (Internal Medicine) Physician	G42150	CA
6	208VP0000X	Pain Medicine Physician	G42150	CA
7	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	G42150	CA
8	207NS0135X	Procedural Dermatology Physician	G42150	CA
9	202K00000X	Phlebology Physician	G42150	CA
10	209800000X	Legal Medicine (M.D./D.O.) Physician	G42150	CA
11	207N00000X	Dermatology Physician	G42150	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XR9324308	OTHER	CA	SAMHSA DATA WAIVER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780641712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT D REITER MD

Provider Business Mailing Address
First Line	:	3010 LINCOLN BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5735
Country	:	US
Telephone Number	:	310-399-9142
Fax Number	:	310-392-4212

Provider Business Practice Location Address
First Line	:	3010 LINCOLN BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5735
Country	:	US
Telephone Number	:	310-399-9142
Fax Number	:	310-392-4212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/24/2010

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