MEDICARE: GENE G REISTER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	DP1436	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659470896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE G REISTER DPM

Provider Business Mailing Address
First Line	:	2001 N COLLINS BLVD
Second Line	:	STE 103
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2636
Country	:	US
Telephone Number	:	972-690-5374
Fax Number	:	972-690-6446

Provider Business Practice Location Address
First Line	:	2001 N COLLINS BLVD
Second Line	:	STE 103
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2636
Country	:	US
Telephone Number	:	972-690-5374
Fax Number	:	972-690-6446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/12/2009

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Directions to “ GENE G REISTER DPM” Practice Location

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