Provider Demographics
NPI:1285718676
Name:REESE, RANDALL E (MD)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:E
Last Name:REESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4951 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8965
Mailing Address - Country:US
Mailing Address - Phone:850-473-0100
Mailing Address - Fax:850-473-0500
Practice Address - Street 1:1368 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3471
Practice Address - Country:US
Practice Address - Phone:850-934-9876
Practice Address - Fax:850-916-0736
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME74566208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256964700Medicaid
FL256964700Medicaid