Provider Demographics
NPI:1013356641
Name:REGINALD L. SYKES, SR, M.D., P.A.
Entity type:Organization
Organization Name:REGINALD L. SYKES, SR, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:904-768-8222
Mailing Address - Street 1:3160 EDGEWOOD AVE W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-2245
Mailing Address - Country:US
Mailing Address - Phone:904-768-8222
Mailing Address - Fax:904-482-0373
Practice Address - Street 1:3160 EDGEWOOD AVE W
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064400500Medicaid
FL064400500Medicaid
FL11409UMedicare PIN