Provider Demographics
NPI:1609972397
Name:REISS, ARTHUR ANSEL (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:ANSEL
Last Name:REISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:#1
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1475
Mailing Address - Country:US
Mailing Address - Phone:415-461-4169
Mailing Address - Fax:415-461-0622
Practice Address - Street 1:1100 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:#1
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1475
Practice Address - Country:US
Practice Address - Phone:415-461-4169
Practice Address - Fax:415-461-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG333092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG333090Medicaid
A45500Medicare UPIN
CAOOG333090Medicare PIN