Individual
WILTON MCLEAN REAVIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1125 US HIGHWAY 98 S, SUITE 101, LAKELAND, FL 33801-5852
(863) 683-7171
Mailing address
1125 US HIGHWAY 98 S, SUITE 101, LAKELAND, FL 33801-5852
(863) 683-7171
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME0031892
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44252600
—
FL
Enumeration date
03/09/2006
Last updated
04/22/2008
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