Provider Demographics
NPI:1942434147
Name:REYNAUD, PETER STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:STEPHEN
Last Name:REYNAUD
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 1:1430 TULANE AVE # 8016
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-7518
Mailing Address - Fax:504-988-8252
Practice Address - Street 1:1430 TULANE AVE # 8016
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2632
Practice Address - Country:US
Practice Address - Phone:504-988-7518
Practice Address - Fax:504-988-8252
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191947207R00000X
LA020944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine