Healthcare Provider Details

I. General information

NPI: 1407840077
Provider Name (Legal Business Name): DAVID WAYNE RIEMANN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 S BROADWAY
LORAIN OH
44053-3820
US

IV. Provider business mailing address

PO BOX 2034
TOLEDO OH
43603-2034
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-8181
  • Fax: 440-233-8182
Mailing address:
  • Phone: 440-233-8181
  • Fax: 440-233-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34004551R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: