Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME 57965 | FL |
NPI | 1043210263 |
---|---|
Provider Name | Robert B Reynolds |
First Address | Altamonte Springs, FL 32701-5002 |
Second Address | Altamonte Springs, FL 32701-5002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
374939800 | (05) | FL |
B99106 | (02) |