Organization
SOUTHEASTERN PODIATRY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL REYNOLDS DPM (PRESIDENT)
(850) 942-0096
Entity
Organization
Contact information
Practice address
1580 WALDO PALMER LN STE 1A, TALLAHASSEE, FL 32308-6049
(850) 942-0096
Mailing address
1580 WALDO PALMER LN STE 1A, TALLAHASSEE, FL 32308-6049
(850) 942-0096
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO2918
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340286000
—
FL
Enumeration date
10/01/2007
Last updated
06/05/2025
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