Provider Demographics
NPI:1568457992
Name:REYNOLDS, MARION ARLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:ARLEEN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 TEXAS BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5117
Mailing Address - Country:US
Mailing Address - Phone:903-794-0888
Mailing Address - Fax:854-854-7171
Practice Address - Street 1:1002 TEXAS BLVD STE 501
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5117
Practice Address - Country:US
Practice Address - Phone:903-794-0888
Practice Address - Fax:854-854-7171
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-12-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
SC81553207V00000X
TXP2351207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3105009-01Medicaid
TX000470731HMedicaid
TXTXB166716Medicare UPIN
GAE90164Medicare UPIN
TX3105009-01Medicaid