MEDICARE: DR. REYNOLD RODNEY MARK D'LIMA M.D.

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	207Q00000X	Family Medicine Physician	00020783	AL

General Provider Information

NPI Number	:	1962472712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REYNOLD RODNEY MARK D'LIMA M.D.

Provider Business Mailing Address
First Line	:	4881 SUGAR MAPLE DRIVE
Second Line	:	FAMILY PRACTICE, WRIGHT PATTERSON AIR FORCE BASE
City	:	DAYTON
State	:	OH
Zip	:	45433-5529
Country	:	US
Telephone Number	:	513-417-2613
Fax Number	:	937-656-1843

Provider Business Practice Location Address
First Line	:	4881 SUGAR MAPLE DRIVE
Second Line	:	FAMILY PRACTICE, WRIGHT PATTERSON AIR FORCE BASE
City	:	DAYTON
State	:	OH
Zip	:	45433-5529
Country	:	US
Telephone Number	:	513-417-2613
Fax Number	:	937-656-1843

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	02/10/2020

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