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NPI Code Detail

MEDICARE: MR. DOUGLAS RE P.A.

MEDICARE: MR. DOUGLAS RE P.A.
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
1363A00000XPhysician AssistantPA9103254FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235174830
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS RE P.A.
Provider Business Mailing Address
First Line : 861 SW 78TH AVE
Second Line : SUITE #100B
City : PLANTATION
State : FL
Zip : 33324-3229
Country : US
Telephone Number : 954-693-0000
Fax Number : 954-693-0005
Provider Business Practice Location Address
First Line : 6001 WEBB RD
Second Line : EMERGENCY DEPARTMENT
City : TAMPA
State : FL
Zip : 33615-3241
Country : US
Telephone Number : 813-888-7060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 05/07/2025

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