Provider Demographics
NPI:1467533927
Name:REYNOLDS, BRIAN
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 GUADALUPE ST
Mailing Address - Street 2:ATTN: REIMBURSEMENT DEPT.
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4110 GUADALUPE ST
Practice Address - Street 2:ATTN: REIMBURSEMENT DEPT.
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4223
Practice Address - Country:US
Practice Address - Phone:512-419-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD51752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00314045Medicare ID - Type UnspecifiedMEDICARE RAILROAD
TXC88279Medicare UPIN
TX88413JMedicare ID - Type Unspecified