Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | ME0074878 | FL |
NPI | 1588720924 |
---|---|
Provider Name | Robert Reid JR. |
First Address | Miami, FL 33144-0602 |
Second Address | Hollywood, FL 33021-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 19/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E22218 | (02) | FL |