Healthcare Provider Details

I. General information

NPI: 1851382402
Provider Name (Legal Business Name): JOCHEN REISER MD ,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 NW 10TH AVE BATCH 633A
MIAMI FL
33136-1013
US

IV. Provider business mailing address

1500 NW 12 AVE JMT EAST 1007
MIAMI FL
33136-1028
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-2349
  • Fax: 305-243-3506
Mailing address:
  • Phone: 305-243-4606
  • Fax: 305-243-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number224081
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME103154
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number224081
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME103154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: