Provider Demographics
NPI:1477671881
Name:REYNOLDS, OSCAR JR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:REYNOLDS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:700 FLOURNOY RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4003
Practice Address - Country:US
Practice Address - Phone:361-664-1417
Practice Address - Fax:361-664-3218
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1135006-02Medicaid
TXG61579Medicare UPIN
TX1135006-02Medicaid