Provider Demographics
NPI:1962483719
Name:REYNOLDS, F DOUGLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:F
Middle Name:DOUGLAS
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1036
Mailing Address - Country:US
Mailing Address - Phone:207-944-8152
Mailing Address - Fax:207-862-6742
Practice Address - Street 1:739 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1036
Practice Address - Country:US
Practice Address - Phone:207-947-2220
Practice Address - Fax:207-947-4073
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD 181213E00000X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126420099Medicaid
MET31296Medicare UPIN
MEMM0287Medicare ID - Type Unspecified