Provider Demographics
NPI:1609971910
Name:REODICA, SOLOMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:
Last Name:REODICA
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 1:4415 HIGHWAY 331 SOUTN
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435
Mailing Address - Country:US
Mailing Address - Phone:850-951-4556
Mailing Address - Fax:850-892-7079
Practice Address - Street 1:4415 HIGHWAY 331 SOUTN
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435
Practice Address - Country:US
Practice Address - Phone:850-951-4556
Practice Address - Fax:850-892-7079
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0025250208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57743Medicare UPIN
67017YMedicare ID - Type Unspecified