Provider Demographics
NPI:1982698692
Name:REID, WITFORD L (MD)
Entity Type:Individual
Prefix:MR
First Name:WITFORD
Middle Name:L
Last Name:REID
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 1:9 RYANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-4075
Mailing Address - Country:US
Mailing Address - Phone:863-471-1413
Mailing Address - Fax:863-471-1416
Practice Address - Street 1:9 RYANT BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-4075
Practice Address - Country:US
Practice Address - Phone:863-471-1413
Practice Address - Fax:863-471-1416
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46267OtherBLUE CROSS BLUE SHIELD
FL255913700Medicaid
FL255913700Medicaid
FLE1893YMedicare PIN