Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | ME-0036763 | FL |
NPI | 1073622833 |
---|---|
Provider Name | Dr. John W. Mcreynolds |
First Address | Atlanta, GA 30384-0001 |
Second Address | Orlando, FL 32806-2944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039341000 | (05) | FL |
D65715 | (02) |