MEDICARE: WILLIAM REYNOLDS PA

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	PA2007	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

General Provider Information

NPI Number	:	1578598710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM REYNOLDS PA

Provider Business Mailing Address
First Line	:	1050 GRAPE AVE
Second Line	:
City	:	ST CLOUD
State	:	FL
Zip	:	34769
Country	:	US
Telephone Number	:	407-343-2003
Fax Number	:	407-892-6468

Provider Business Practice Location Address
First Line	:	105 N DOVERPLUM AVE
Second Line	:
City	:	POINCIANA
State	:	FL
Zip	:	34758
Country	:	US
Telephone Number	:	407-943-8600
Fax Number	:	407-943-8625

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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