Provider Demographics
NPI:1255304515
Name:REYNOLDS, DOROTHY L (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZEARING
Mailing Address - State:IA
Mailing Address - Zip Code:50278
Mailing Address - Country:US
Mailing Address - Phone:641-487-7779
Mailing Address - Fax:641-487-7749
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ZEARING
Practice Address - State:IA
Practice Address - Zip Code:50278
Practice Address - Country:US
Practice Address - Phone:641-487-7779
Practice Address - Fax:641-487-7749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3039776Medicaid
IA37095OtherBCBS
IA4039776Medicaid
IA2039776Medicaid
IA37094OtherBCBS
IA0634600Medicaid
IA37096OtherBCBS
IA0634600Medicaid
IAI12682Medicare ID - Type Unspecified
IA3039776Medicaid
IA2039776Medicaid