Healthcare Provider Details

I. General information

NPI: 1962472712
Provider Name (Legal Business Name): REYNOLD RODNEY MARK D'LIMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DRIVE FAMILY PRACTICE, WRIGHT PATTERSON AIR FORCE BASE
DAYTON OH
45433-5529
US

IV. Provider business mailing address

4881 SUGAR MAPLE DRIVE FAMILY PRACTICE, WRIGHT PATTERSON AIR FORCE BASE
DAYTON OH
45433-5529
US

V. Phone/Fax

Practice location:
  • Phone: 513-417-2613
  • Fax: 937-656-1843
Mailing address:
  • Phone: 513-417-2613
  • Fax: 937-656-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00020783
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: