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General NPI Number Information
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NPI Number | 1174691489
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Entity Type | Individual
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Provider Name | PAUL D REYNOLDS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 1580 WALDO PALMER LN STE 1A
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City | TALLAHASSEE
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State | FL
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Zip | 32308-6049
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Country | US
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Telephone | 850-942-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 2858 MAHAN DR SUITE 1 & 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5446
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Country | US
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Telephone | 850-942-0096
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Fax |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2918
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License Number State | FL
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