Provider Demographics
NPI:1073863213
Name:REYNOLDS, JOSHUA J (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1704
Mailing Address - Country:US
Mailing Address - Phone:303-595-2727
Mailing Address - Fax:303-595-2626
Practice Address - Street 1:11700 W 2ND PL
Practice Address - Street 2:SUITE 350
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1704
Practice Address - Country:US
Practice Address - Phone:303-595-2727
Practice Address - Fax:303-595-2626
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055722363AM0700X
COPA0004176363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical