MEDICARE: ANDREW EARL REID PA-C

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	363A00000X	Physician Assistant	PA9106515	FL

General Provider Information

NPI Number	:	1063777431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW EARL REID PA-C

Provider Business Mailing Address
First Line	:	4140 NW 12TH ST
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5816
Country	:	US
Telephone Number	:	954-739-3331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 NW 12TH ST
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5816
Country	:	US
Telephone Number	:	954-739-3331
Fax Number	:

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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