Individual
MR. REGINALD DYWANE BYRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
328 SE 4TH ST, HAVANA, FL 32333-2150
(850) 539-6282
Mailing address
328 SE 4TH ST, HAVANA, FL 32333-2150
(850) 539-6282
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
AL12271
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
466375
MEDICAID ENROLLMENT FILE NUMBER
FL
Enumeration date
12/26/2012
Last updated
12/26/2012
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