Provider Demographics
NPI:1780762849
Name:REESE, BRADLEY R (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:R
Last Name:REESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1781 PARK CENTER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6254
Mailing Address - Country:US
Mailing Address - Phone:407-351-0675
Mailing Address - Fax:407-352-1867
Practice Address - Street 1:1781 PARK CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6254
Practice Address - Country:US
Practice Address - Phone:407-351-0675
Practice Address - Fax:407-352-1867
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME50851207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251669100Medicaid
FL03868Medicare ID - Type Unspecified
FLD50858Medicare UPIN