Provider Demographics
NPI:1164453734
Name:REYNOLDS, IVONNE M (DO)
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2964 N STATE ROAD 7
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5715
Mailing Address - Country:US
Mailing Address - Phone:954-917-4997
Mailing Address - Fax:954-917-5404
Practice Address - Street 1:2964 NORTH STATE ROAD 7
Practice Address - Street 2:SUITE 310
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-917-4997
Practice Address - Fax:954-917-5404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8415207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261981400Medicaid
FL58924YMedicare UPIN
FLH42108Medicare UPIN