Healthcare Provider Details

I. General information

NPI: 1174584619
Provider Name (Legal Business Name): YURI E REINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CHILDRENS WAY
JACKSONVILLE FL
32207-8426
US

IV. Provider business mailing address

2530 CHICAGO AVE #550
MINNEAPOLIS MN
55404-4289
US

V. Phone/Fax

Practice location:
  • Phone: 904-697-3600
  • Fax: 904-697-3927
Mailing address:
  • Phone: 612-813-8000
  • Fax: 612-813-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number30855
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME138919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: