Individual
GERALD EDWARD REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4685 N HIGHWAY 19A, MOUNT DORA, FL 32757-2039
(352) 589-5900
(352) 589-5904
Mailing address
10250 SE 167TH PLACE RD, SUITE 5-1, SUMMERFIELD, FL 34491-8686
(352) 307-9925
(352) 347-1703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS0003577
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038568900
—
FL
01
—
080130087
MEDICARE RAILROAD
FL
Enumeration date
09/28/2006
Last updated
11/20/2014
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