Provider Demographics
NPI:1619926227
Name:REISMAN, TERENCE N (M D)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:N
Last Name:REISMAN
Suffix:
Gender:M
Credentials:M D
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5314
Mailing Address - Country:US
Mailing Address - Phone:850-431-7900
Mailing Address - Fax:850-431-7990
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5314
Practice Address - Country:US
Practice Address - Phone:850-431-7900
Practice Address - Fax:850-431-7990
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 15393207RG0100X
FLME15393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37199XOtherBCBS PROVIDER NUMBER
FL055323900Medicaid
FL37199XMedicare Oscar/Certification
FLD54571Medicare UPIN