Healthcare Provider Details

I. General information

NPI: 1922859529
Provider Name (Legal Business Name): GARETH ALWAYNE REID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 POINTE WEST DR STE 101
VERO BEACH FL
32966-1308
US

IV. Provider business mailing address

1935 NW 171ST AVE
PEMBROKE PINES FL
33028-2042
US

V. Phone/Fax

Practice location:
  • Phone: 772-564-7828
  • Fax: 772-567-6107
Mailing address:
  • Phone: 954-258-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME179082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: