Provider Demographics
NPI:1104928399
Name:REINHARDT, LINDA A (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 HARRISON ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1360
Mailing Address - Country:US
Mailing Address - Phone:940-763-1200
Mailing Address - Fax:940-763-1207
Practice Address - Street 1:2601 HARRISON ST
Practice Address - Street 2:STE 500
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1360
Practice Address - Country:US
Practice Address - Phone:940-322-9606
Practice Address - Fax:940-322-9241
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1930207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140820501Medicaid
TX140820501Medicaid
TXB25860Medicare UPIN