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General NPI Number Information
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NPI Number | 1003882069
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Entity Type | Individual
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Provider Name | REYNALD POULIOT M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 265B COMMERCIAL BLVD
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-4442
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Country | US
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Telephone | 954-772-3960
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Fax | 954-772-3981
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Provider Business Mailing Address
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Address Line | 265B COMMERCIAL BLVD
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-4442
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Country | US
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Telephone | 954-772-3960
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Fax | 954-772-3981
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME 36312
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License Number State | FL
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