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General NPI Number Information
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NPI Number | 1700900461
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Entity Type | Organization
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Legal Business Name | WILBUR R. RESCHLY, M.D., P.A.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4316 HIGHLAND PARK BLVD
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City | LAKELAND
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State | FL
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Zip | 33813-1647
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Country | US
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Telephone | 863-644-6415
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Fax | 863-709-8345
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Provider Business Mailing Address
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Address Line | 4316 HIGHLAND PARK BLVD
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City | LAKELAND
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State | FL
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Zip | 33813-1647
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Country | US
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Telephone | 863-644-6415
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Fax | 863-709-8345
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILBUR R RESCHLY
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Credential | M.D.
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Telephone | 863-644-6415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME24895
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License Number State | FL
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