Provider Demographics
NPI:1437619103
Name:REYNOLDS, JASON WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3215
Mailing Address - Country:US
Mailing Address - Phone:352-797-3500
Mailing Address - Fax:352-797-3526
Practice Address - Street 1:44 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3215
Practice Address - Country:US
Practice Address - Phone:352-797-3500
Practice Address - Fax:352-797-3526
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164291207QS0010X
MI4301506961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine