Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME 36312 | FL |
NPI | 1003882069 |
---|---|
Provider Name | Dr. Reynald Pouliot |
First Address | Lauderdale By The Sea, FL 33308-4442 |
Second Address | Lauderdale By The Sea, FL 33308-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 15/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065023400 | (05) | FL |
07023720 | UNITED (01) | FL |
2080754 | AETNA HMO (01) | FL |
257650 | AVMED (01) | FL |
3967705006 | CIGNA (01) | FL |
4421890 | AETNA PPO (01) | FL |
93842 | BC/BS OF FL (01) | FL |
E12196 | (02) | FL |