Provider Demographics
NPI:1427132703
Name:REIS, DAVID G
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:REIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 NORTHDALE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1893
Mailing Address - Country:US
Mailing Address - Phone:800-991-6117
Mailing Address - Fax:888-812-8191
Practice Address - Street 1:635 MADISON AVE FL 1400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1036
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029939207R00000X
NY159882202K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTMEDICAREOther060001509
CT3007522/4124373OtherAETNA
CTP2723932OtherOXFORD
CT208799OtherWELLCARE
CT3V4063OtherHEALTHNET
CTP00017040OtherRR MEDICARE
CT010029939CT06OtherANTHEM BCBS CT
CT09-45753OtherAMERICHOICE
CT716909-H055OtherCONNECTICARE
CT232509OtherUSA
CT09-45753OtherUHC
CT3V4063OtherHEALTHNET