Healthcare Provider Details

I. General information

NPI: 1568401313
Provider Name (Legal Business Name): JERALD W REINHARDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 CENTRAL AVE NE
EAST GRAND FORKS MN
56721-1605
US

IV. Provider business mailing address

212 PLAIN HILLS DR
GRAND FORKS ND
58201-7942
US

V. Phone/Fax

Practice location:
  • Phone: 866-773-1390
  • Fax:
Mailing address:
  • Phone: 701-772-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number29094
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: