Healthcare Provider Details

I. General information

NPI: 1023089620
Provider Name (Legal Business Name): JAY A REICHBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 W BOY SCOUT BLVD SUITE 400
TAMPA FL
33607-5724
US

IV. Provider business mailing address

4211 W BOY SCOUT BLVD STE 400
TAMPA FL
33607-5766
US

V. Phone/Fax

Practice location:
  • Phone: 855-485-3262
  • Fax: 813-443-8255
Mailing address:
  • Phone: 352-302-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME68278
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number270089-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2011-01321
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: