Provider Demographics
NPI:1124448071
Name:REZAC, KYLE A (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:REZAC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:1348 S 18TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4785
Practice Address - Country:US
Practice Address - Phone:904-261-0922
Practice Address - Fax:904-390-7477
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2024-11-26
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Provider Licenses
StateLicense IDTaxonomies
GA078726207Q00000X
FLOS14025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine