Provider Demographics
NPI:1891774410
Name:REYNOLDS, WILLIAM WAYLAND JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAYLAND
Last Name:REYNOLDS
Suffix:JR
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:DEPARTMENT OF RADIOLOGY
Mailing Address - Street 2:PSC 490 BOX 7716
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538
Mailing Address - Country:US
Mailing Address - Phone:671-685-2024
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF RADIOLOGY
Practice Address - Street 2:PSC 490 BOX 7716
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538
Practice Address - Country:US
Practice Address - Phone:671-685-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059675A2083A0100X, 2085R0202X
WAMD611387852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine