Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | ME72338 | FL |
NPI | 1154394385 |
---|---|
Provider Name | Jonathan David Reich |
First Address | Lakeland, FL 33804-5004 |
Second Address | Lakeland, FL 33805-3019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 26/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254885200 | (05) | FL |
G70195 | (02) |