Provider Demographics
NPI:1528279783
Name:REUTER, ROBERT MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARTIN
Last Name:REUTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1051512085R0202X
VAA998342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A998340OtherBLUE SHIELD
CA00A998340Medicaid
CAWA99834BMedicare PIN
CAAO322XMedicare PIN
CAAO322ZMedicare PIN
CAWA99834DMedicare PIN
CA00A998340Medicare PIN
CAAO322YMedicare PIN
CAWA99834EMedicare PIN
CAWA99834CMedicare PIN
CAH10727Medicare UPIN
CAWA99834AMedicare PIN
CA00A998341Medicare PIN
CA00A998340OtherBLUE SHIELD
CAAO322WMedicare PIN