Provider Demographics
NPI:1770781148
Name:RIESINGER, JASON D (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:RIESINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:DAVID
Other - Last Name:RIESINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2400 N ROCKTON AVE
Mailing Address - Street 2:ROCKFORD HEALTH PHYSICIANS
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3655
Mailing Address - Country:US
Mailing Address - Phone:815-971-3333
Mailing Address - Fax:815-968-0360
Practice Address - Street 1:2400 N ROCKTON AVE
Practice Address - Street 2:ROCKFORD HEALTH PHYSICIANS
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3655
Practice Address - Country:US
Practice Address - Phone:815-971-3333
Practice Address - Fax:815-968-0360
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118261207PE0004X
TN54319207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services