Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME63906 | FL |
Y | 207RX0202X | Medical Oncology | ME63906 | FL |
NPI | 1235199878 |
---|---|
Provider Name | Dr. Craig Harry Reynolds |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Ocala, FL 34471-5472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
372653300 | (05) | FL |
830008323 | RAILROAD MEDICARE (01) | FL |
F55096 | (02) |