Healthcare Provider Details

I. General information

NPI: 1679619423
Provider Name (Legal Business Name): EDWARD J. REISMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W NORTH RIVER DR
SPOKANE WA
99201-3208
US

IV. Provider business mailing address

322 W NORTH RIVER DR
SPOKANE WA
99201-3208
US

V. Phone/Fax

Practice location:
  • Phone: 509-324-6464
  • Fax:
Mailing address:
  • Phone: 509-324-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00024932
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD00024932
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: