Individual
FREDERICK C REAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2727 WINKLER AVE, FORT MYERS, FL 33901-9358
(239) 939-8611
(904) 346-0113
Mailing address
PO BOX 634748, CINCINNATI, OH 45263-0042
(239) 337-7700
(904) 346-0113
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA12718
CA
363A00000X
Physician Assistant
Primary
PA9103819
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023194750
—
CA
Enumeration date
10/27/2006
Last updated
03/05/2009
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