Provider Demographics
NPI:1285710152
Name:REISMAN, DAVID (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:REISMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 GULF BREEZE PKWY # 140
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4492
Mailing Address - Country:US
Mailing Address - Phone:734-929-7503
Mailing Address - Fax:
Practice Address - Street 1:87 MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3765
Practice Address - Country:US
Practice Address - Phone:603-629-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105054207RH0003X, 207RX0202X
NH21605207RX0202X
COCDRH.0062072207RX0202X
NC9701559207RX0202X
FL21605207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001318400Medicaid
FLCH546ZMedicare PIN
FL001318400Medicaid
MI0H17613691Medicare ID - Type Unspecified
MI4447320Medicaid