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NPI Code Detail

MEDICARE: DR. COURTNEY S REIDY MD

MEDICARE: DR. COURTNEY S REIDY MD
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
1207R00000XInternal Medicine Physician01012333389VA
2208M00000XHospitalist PhysicianME97574FL
3207R00000XInternal Medicine PhysicianME97574FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
391847OTHERFLBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316916265
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COURTNEY S REIDY MD
Provider Business Mailing Address
First Line : 1200 RIVERPLACE BLVD
Second Line : SUITE 620
City : JACKSONVILLE
State : FL
Zip : 32207-9046
Country : US
Telephone Number : 904-396-6620
Fax Number : 904-396-6528
Provider Business Practice Location Address
First Line : 1200 RIVERPLACE BLVD
Second Line : SUITE 620
City : JACKSONVILLE
State : FL
Zip : 32207-9046
Country : US
Telephone Number : 904-396-6620
Fax Number : 904-396-6528
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 01/15/2025

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Directions to “ DR. COURTNEY S REIDY MD” Practice Location

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