Provider Demographics
NPI:1407013931
Name:ROBERT REID JR MD PA
Entity Type:Organization
Organization Name:ROBERT REID JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:954-989-5010
Mailing Address - Street 1:PO BOX 440602
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-0602
Mailing Address - Country:US
Mailing Address - Phone:786-275-8404
Mailing Address - Fax:786-275-8403
Practice Address - Street 1:1131 N 35TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5403
Practice Address - Country:US
Practice Address - Phone:954-989-5010
Practice Address - Fax:954-989-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00748782080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253949700Medicaid