Provider Demographics
NPI:1760463426
Name:REYNOLDS, GEORGE ES (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ES
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 1:17150 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2738
Mailing Address - Country:US
Mailing Address - Phone:281-488-6347
Mailing Address - Fax:281-488-7609
Practice Address - Street 1:17150 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2738
Practice Address - Country:US
Practice Address - Phone:281-488-6347
Practice Address - Fax:281-488-7609
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9625208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE46795Medicare UPIN