Provider Demographics
NPI:1922075647
Name:REYNOLDS, JAY BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:BRIAN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2756
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00018611207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010146345OtherREGENCE BLUE SHIELD OF ID
WA50594OtherDEPT OF LABOR & INDUSTRIE
WA8938899OtherCRIME VICTIMS
MT0082229Medicaid
WA5870REOtherASURIS NW HEALTH
IDKV510OtherBLUE CROSS OF IDAHO
WAP00092594OtherRR MEDICARE
WA1073451Medicaid
G8801891OtherMEDICARE ID
WA930OtherGROUP HEALTH NW
WA50594OtherDEPT OF LABOR & INDUSTRIE