Provider Demographics
NPI:1790730661
Name:SYKES, REGINALD L (MD)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:L
Last Name:SYKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 61148
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32236-1148
Mailing Address - Country:US
Mailing Address - Phone:904-400-6100
Mailing Address - Fax:904-400-6102
Practice Address - Street 1:3160 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-2245
Practice Address - Country:US
Practice Address - Phone:904-768-8222
Practice Address - Fax:904-482-0373
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0058350207Q00000X
FLME58350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064400500Medicaid
FL11409UMedicare PIN
FLE60475Medicare UPIN