MEDICARE: DR. REYNALD POULIOT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME 36312	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4421890	OTHER	FL	AETNA PPO
3	07023720	OTHER	FL	UNITED
4	2080754	OTHER	FL	AETNA HMO
5	93842	OTHER	FL	BC/BS OF FL
6	257650	OTHER	FL	AVMED
7	3967705006	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1003882069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REYNALD POULIOT M.D.

Provider Business Mailing Address
First Line	:	265B COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4442
Country	:	US
Telephone Number	:	954-772-3960
Fax Number	:	954-772-3981

Provider Business Practice Location Address
First Line	:	265B COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4442
Country	:	US
Telephone Number	:	954-772-3960
Fax Number	:	954-772-3981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	05/15/2012

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Directions to “ DR. REYNALD POULIOT M.D.” Practice Location

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