Healthcare Provider Details

I. General information

NPI: 1356495998
Provider Name (Legal Business Name): NANCY M REIERSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 UNIVERSITY DR SUITE 301
CORAL GABLES FL
33146-2008
US

IV. Provider business mailing address

PO BOX 330157
MIAMI FL
33233-0157
US

V. Phone/Fax

Practice location:
  • Phone: 786-308-3000
  • Fax: 786-308-3402
Mailing address:
  • Phone: 305-669-3320
  • Fax: 305-669-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBT-0017010430
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberBT-0017010430
License Number StateFL

VIII. Authorized Official

Name: NANCY M REIERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 305-669-3320