Provider Demographics
NPI:1346289618
Name:REYNOLDS, TOMMY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:R
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5009
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3519208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0002025OtherSD BCBS
931451029046OtherPREFERRED ONE
24691OtherHEALTH PARTNERS
165034OtherUCARE
MN1M361REOtherMN BCBS - PLAN 91057NO
SD7300540Medicaid
IA0982801Medicaid
MN496L4REOtherMN BC BS
18-00050OtherMEDICA SELECTCARE
SD3519OtherDAKOTACARE
SDB74788Medicare UPIN
SD7300540Medicaid