Healthcare Provider Details

I. General information

NPI: 1578973863
Provider Name (Legal Business Name): DANA L. REISS, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 HUEBNER RD 250
SAN ANTONIO TX
78240-1558
US

IV. Provider business mailing address

9150 HUEBNER RD 250
SAN ANTONIO TX
78240-1558
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-9210
  • Fax: 210-614-6859
Mailing address:
  • Phone: 210-614-9210
  • Fax: 210-614-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL0538
License Number StateTX

VIII. Authorized Official

Name: MRS. MARY BURCHETT
Title or Position: PROVIDER REALTIONS
Credential:
Phone: 210-508-6214