Provider Demographics
NPI:1720073547
Name:REESE, WILLIAM ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:REESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 MARIBELLA DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5331
Mailing Address - Country:US
Mailing Address - Phone:540-220-8083
Mailing Address - Fax:
Practice Address - Street 1:1 AEROSPACE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3910
Practice Address - Country:US
Practice Address - Phone:386-226-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047986207Q00000X
FLME157057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005854679Medicaid
VA49D1807406OtherCLIA
DD9150OtherMEDICARE RAILROAD
F65320Medicare UPIN
DD9150OtherMEDICARE RAILROAD
VAF65320Medicare UPIN
VA00V025W86Medicare ID - Type Unspecified
VA005854679Medicaid