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General NPI Number Information
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NPI Number | 1073622833
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Entity Type | Individual
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Provider Name | JOHN W. MCREYNOLDS MD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 1717 S ORANGE AVE SUITE 100
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City | ORLANDO
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State | FL
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Zip | 32806-2944
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Country | US
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Telephone | 407-650-7000
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Fax | 407-650-7124
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Provider Business Mailing Address
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Address Line | NEMOURS CHILDREN&APOS S CLINIC PO BOX 409992
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City | ATLANTA
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State | GA
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Zip | 30384-0001
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Country | US
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Telephone | 904-390-3610
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Fax | 904-288-5890
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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 | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | ME-0036763
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License Number State | FL
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