Provider Demographics
NPI:1427184233
Name:REYNOLDS, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4820 HARWOOD ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5276
Mailing Address - Country:US
Mailing Address - Phone:408-264-7700
Mailing Address - Fax:408-264-7701
Practice Address - Street 1:4820 HARWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5200
Practice Address - Country:US
Practice Address - Phone:408-264-7700
Practice Address - Fax:408-264-7701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64135207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427184233Medicare UPIN