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General NPI Number Information
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NPI Number | 1467537357
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Entity Type | Individual
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Provider Name | LEWIS REISMAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 1501 KINGS HWY SUITE 101
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City | SHREVEPORT
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State | LA
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Zip | 71103
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Country | US
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Telephone | 318-675-8631
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Fax | 318-675-8634
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Provider Business Mailing Address
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Address Line | 1512 W. KIRBY PLACE
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City | SHREVEPORT
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State | LA
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Zip | 71103
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Country | US
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Telephone | 318-675-4881
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Fax | 318-675-7531
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | MA62698
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD.202441
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | MD.202441
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | 202441
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License Number State | LA
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