Provider Demographics
NPI:1700843695
Name:REYNOLDS, CHRISTOPHER JAY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAY
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 1:52 N 1100 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2952
Mailing Address - Country:US
Mailing Address - Phone:801-763-0901
Mailing Address - Fax:801-763-0903
Practice Address - Street 1:52 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2952
Practice Address - Country:US
Practice Address - Phone:801-763-0901
Practice Address - Fax:801-763-0903
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT173564-12052084S0012X, 2084N0400X
WY7014A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33644Medicare UPIN
WYW10156Medicare PIN