Provider Demographics
NPI:1215900659
Name:REINOSO, JOSE GABRIEL (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:GABRIEL
Last Name:REINOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4315 HIGHLAND PARK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1639
Mailing Address - Country:US
Mailing Address - Phone:727-669-3800
Mailing Address - Fax:727-669-5600
Practice Address - Street 1:4315 HIGHLAND PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1639
Practice Address - Country:US
Practice Address - Phone:727-669-3800
Practice Address - Fax:813-677-5690
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267286300Medicaid
FL78765ZMedicare PIN
H90355Medicare UPIN