Healthcare Provider Details

I. General information

NPI: 1407013931
Provider Name (Legal Business Name): ROBERT REID JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N 35TH AVE STE 310
HOLLYWOOD FL
33021-5403
US

IV. Provider business mailing address

PO BOX 440602
MIAMI FL
33144-0602
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-5010
  • Fax: 954-989-6430
Mailing address:
  • Phone: 786-275-8404
  • Fax: 786-275-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberME0074878
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT REID JR.
Title or Position: OWNER
Credential: MD
Phone: 954-989-5010