Basic Information
| Provider Information | |||||||||
| NPI: | 1568559938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4828 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504778109 | ||||||||
| FaxNumber: | 8504782412 | ||||||||
| Practice Location | |||||||||
| Address1: | 4531 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504364563 | ||||||||
| FaxNumber: | 8504364570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME0090180 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 002409269001 | 01 | UNITED HEALTH CARE | OTHER | P00166603 | 01 | RAILROAD MEDICARE | OTHER | 059172000 | 01 | AL | BCBS OF ALABAMA | OTHER | 270037900 | 05 | FL | MEDICAID | 43290 | 01 | FL | BCBS OF FLORIDA | OTHER | 009970645 | 05 | AL | MEDICAID | 0651178 | 01 | CIGNA | OTHER | 7233548 | 01 | AETNA | OTHER | C809 | 01 | HEALTH OPTIONS | OTHER |