Provider Demographics
NPI:1669436770
Name:REYNOLDS, MICHAEL BRYAN (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRYAN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:3480 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2917
Practice Address - Country:US
Practice Address - Phone:352-600-7900
Practice Address - Fax:352-600-8994
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8977207Q00000X
FLOS9017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01346411OtherRAIL ROAD MEDICARE
FL268005000Medicaid
FL81409OtherBLUE CROSS BLUE SHIELD
FLP00224044OtherRRM
TX8CU379OtherBCBSTX
FLD60732Medicare UPIN
FLP00224044OtherRRM
FLP01346411OtherRAIL ROAD MEDICARE