Provider Demographics
NPI:1386632990
Name:REYNOLDS, PATRICK T (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:T
Last Name:REYNOLDS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12335 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026
Mailing Address - Country:US
Mailing Address - Phone:954-265-4325
Mailing Address - Fax:954-276-0744
Practice Address - Street 1:12235 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4119
Practice Address - Country:US
Practice Address - Phone:954-265-4325
Practice Address - Fax:954-450-4422
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME565092084P0800X, 2084P2900X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF01267Medicare UPIN
FL12791YMedicare ID - Type Unspecified