Provider Demographics
NPI:1568582765
Name:REYNOLDS NEUROLOGY PC
Entity Type:Organization
Organization Name:REYNOLDS NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-780-8838
Mailing Address - Street 1:19841 N 27TH AVE
Mailing Address - Street 2:403
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4003
Mailing Address - Country:US
Mailing Address - Phone:623-780-8838
Mailing Address - Fax:623-780-9150
Practice Address - Street 1:19841 N 27TH AVE
Practice Address - Street 2:403
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4003
Practice Address - Country:US
Practice Address - Phone:623-780-8838
Practice Address - Fax:623-780-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH23228Medicare UPIN