Provider Demographics
NPI: | 1851658900 |
---|---|
Name: | REYNOLDS, ADAM (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ADAM |
Middle Name: | |
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: | 7150 N PRESIDENT GEORGE BUSH HWY STE 206 |
Mailing Address - Street 2: | |
Mailing Address - City: | GARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75044-2208 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-276-8994 |
Mailing Address - Fax: | 844-292-1462 |
Practice Address - Street 1: | 7150 N PRESIDENT GEORGE BUSH HWY STE 206 |
Practice Address - Street 2: | |
Practice Address - City: | GARLAND |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75044-2208 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-276-8994 |
Practice Address - Fax: | 844-292-1462 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-04-13 |
Last Update Date: | 2022-09-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 57.021667 | 207R00000X |
TX | R6882 | 207UN0901X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |