Provider Demographics
NPI:1235199878
Name:REYNOLDS, CRAIG HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:HARRY
Last Name:REYNOLDS
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:1630 SE 18TH ST
Practice Address - Street 2:BLDG 600. STE 602
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5472
Practice Address - Country:US
Practice Address - Phone:352-369-0181
Practice Address - Fax:352-369-0246
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63906207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL830008323OtherRAILROAD MEDICARE
FL372653300Medicaid
F55096Medicare UPIN
FL372653300Medicaid
FL18737SMedicare PIN