Provider Demographics
NPI:1194752840
Name:REIDY, PATRICK M (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:REIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 IMMOKALEE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1422
Mailing Address - Country:US
Mailing Address - Phone:239-514-2225
Mailing Address - Fax:239-514-2280
Practice Address - Street 1:2180 IMMOKALEE RD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1422
Practice Address - Country:US
Practice Address - Phone:239-514-2225
Practice Address - Fax:239-514-2280
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92444207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272799400Medicaid
FL13299OtherBLUE SHIELD PROVIDER #
FLH78050Medicare UPIN
FL13299ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER#