Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | ME85548 | FL |
NPI | 1023187424 |
---|---|
Provider Name | Dr. Edward Craig Reller |
First Address | Dover, FL 33527 |
Second Address | Dover, FL 33527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 11/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265727900 | (05) | FL |
B94798 | (02) | FL |