Provider Demographics
NPI:1760443857
Name:REYNOLDS, WILLIAM EMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EMERY
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 268947
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8947
Mailing Address - Country:US
Mailing Address - Phone:405-321-5683
Mailing Address - Fax:405-329-0486
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9322
Practice Address - Country:US
Practice Address - Phone:405-755-3540
Practice Address - Fax:405-755-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
OK13840207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35189Medicare UPIN