Provider Demographics
NPI:1386632990
Name:REYNOLDS, PATRICK T (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:T
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 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-265-4325
Mailing Address - Fax:954-276-0744
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:SUITE 151
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-265-4325
Practice Address - Fax:954-276-0744
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF01267Medicare UPIN
FL12791YMedicare ID - Type Unspecified