Provider Demographics
NPI:1831293141
Name:ALLAM, REYNALD C (MD)
Entity Type:Individual
Prefix:
First Name:REYNALD
Middle Name:C
Last Name:ALLAM
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 1:1285 CREEKSIDE BLVD E UNIT 104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0595
Mailing Address - Country:US
Mailing Address - Phone:239-624-0630
Mailing Address - Fax:239-624-0631
Practice Address - Street 1:1285 CREEKSIDE BLVD E UNIT 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0595
Practice Address - Country:US
Practice Address - Phone:239-624-0630
Practice Address - Fax:239-624-0631
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68021207R00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42522WOtherMEDICARE
FL023226000Medicaid
FL42522OtherBCBS