MEDICARE: REEDER MEDICAL GROUP LLC

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	207R00000X	Internal Medicine Physician	ME0007163	FL

General Provider Information

NPI Number	:	1164798245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REEDER MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	1400 S ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1840
Country	:	US
Telephone Number	:	954-764-8911
Fax Number	:	954-764-2150

Provider Business Practice Location Address
First Line	:	1400 S ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1840
Country	:	US
Telephone Number	:	954-764-8911
Fax Number	:	954-764-2150

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROBERT LOVE REEDER
Credential	:	M.D.
Telephone Number	:	954-240-4320

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	07/29/2013

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