Provider Demographics
NPI:1598863722
Name:REYNOLDS, LYNNE M (MD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2594207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX059785804Medicaid
TXTXB114166Medicare PIN
TX00N47FMedicare PIN
TX00N47FMedicare PIN
TX8645J5Medicare PIN
TX122394100OtherFIRSTCARE PIN
1447220850OtherGRP NPI NUMBER
TX88414YOtherBCBSTX IND PIN
TX059785802Medicaid
E89038Medicare UPIN
TX124180OtherSUPERIOR PIN
TX140442853Medicaid
TX10027155OtherAMERIGROUP PIN
TX1068058OtherUHC PIN
TX3539287OtherCIGNA PIN
TX76405OtherFIRSTHEALTH PIN
TX9218992OtherPHCS PIN
TX137345809Medicaid