Provider Demographics
NPI:1083672380
Name:SCHUTT-AINE, REGINALD LUC MARIE (MD)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:LUC MARIE
Last Name:SCHUTT-AINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 N STONE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0919
Mailing Address - Country:US
Mailing Address - Phone:386-943-7100
Mailing Address - Fax:386-738-2624
Practice Address - Street 1:1070 N STONE ST
Practice Address - Street 2:SUITE A
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0919
Practice Address - Country:US
Practice Address - Phone:386-943-7100
Practice Address - Fax:386-738-2624
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255153500Medicaid
FL43593XMedicare ID - Type UnspecifiedMEDICARE NO
FL255153500Medicaid