Provider Demographics
NPI:1568559938
Name:REILLY, PATRICK FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:FRANCIS
Last Name:REILLY
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 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:4531 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2770
Practice Address - Country:US
Practice Address - Phone:850-436-4563
Practice Address - Fax:850-436-4570
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0090180207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002409269001OtherUNITED HEALTH CARE
P00166603OtherRAILROAD MEDICARE
AL059172000OtherBCBS OF ALABAMA
FL270037900Medicaid
FL43290OtherBCBS OF FLORIDA
AL009970645Medicaid
0651178OtherCIGNA
7233548OtherAETNA
C809OtherHEALTH OPTIONS
0651178OtherCIGNA
I10825Medicare UPIN