MEDICARE: DAVID KENNETH 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	2084N0400X	Neurology Physician	3529	AZ
2	2084N0400X	Neurology Physician	OS18424	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68935	OTHER	AZ	MEDICARE GROUP NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1942207477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KENNETH REYNOLDS D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-345-9235
Fax Number	:	239-343-4008

Provider Business Practice Location Address
First Line	:	12600 CREEKSIDE LN STE 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3353
Country	:	US
Telephone Number	:	239-343-9235
Fax Number	:	239-343-4008

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	01/08/2025

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Directions to “ DAVID KENNETH REYNOLDS D.O.” Practice Location

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