Provider Demographics
NPI:1629044409
Name:REID, MATTHEW T (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:REID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KEY HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6221
Mailing Address - Country:US
Mailing Address - Phone:305-890-6425
Mailing Address - Fax:
Practice Address - Street 1:101 KEY HAVEN RD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6221
Practice Address - Country:US
Practice Address - Phone:305-890-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-12-11
Deactivation Date:2012-11-14
Deactivation Code:
Reactivation Date:2013-12-11
Provider Licenses
StateLicense IDTaxonomies
FLOS9716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine