Provider Demographics
NPI:1568642353
Name:REYNOLDS, JUSTIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:A
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 1:500 W THOMAS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4220
Mailing Address - Country:US
Mailing Address - Phone:602-406-4000
Mailing Address - Fax:602-406-6498
Practice Address - Street 1:500 W THOMAS RD STE 480
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4239
Practice Address - Country:US
Practice Address - Phone:602-406-5483
Practice Address - Fax:602-406-5488
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100903207R00000X
AZ42634207R00000X, 207RG0100X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ928237Medicaid