Basic Information
| Provider Information | |||||||||
| NPI: | 1023118981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIEHN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742318 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303742318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176149863 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6201 N SUNCOAST BLVD | ||||||||
| Address2: | |||||||||
| City: | CRYSTAL RIVER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344286712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527954008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OS11146 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 5101010556 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 4471370-11 | 05 | MI | MEDICAID | 003277000 | 05 | FL | MEDICAID | ER333Z | 01 | FL | MEDICARE | OTHER |