MEDICARE: DR. MATTHEW REYNOLDS D.O.

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	208600000X	Surgery Physician	OS12151	FL
2	208600000X	Surgery Physician	UO2790	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	:	1760762629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW REYNOLDS D.O.

Provider Business Mailing Address
First Line	:	11200 SEMINOLE BLVD STE 210
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3239
Country	:	US
Telephone Number	:	727-584-9500
Fax Number	:	727-914-8529

Provider Business Practice Location Address
First Line	:	11200 SEMINOLE BLVD STE 210
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3239
Country	:	US
Telephone Number	:	727-584-9500
Fax Number	:	727-914-8529

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

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	01/28/2019

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