Healthcare Provider Details

I. General information

NPI: 1831293141
Provider Name (Legal Business Name): REYNALD C ALLAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 CREEKSIDE BLVD E UNIT 104
NAPLES FL
34109-0595
US

IV. Provider business mailing address

1285 CREEKSIDE BLVD E UNIT 104
NAPLES FL
34109-0595
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0630
  • Fax: 239-624-0631
Mailing address:
  • Phone: 239-624-0630
  • Fax: 239-624-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME68021
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME68021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: