Provider Demographics
NPI:1972613321
Name:REYNOLDS, JOEL CRIST (MD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:CRIST
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:210 N BROAD ST
Mailing Address - Street 2:EDENTON UROLOGY CLINIC
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932
Mailing Address - Country:US
Mailing Address - Phone:252-482-1606
Mailing Address - Fax:252-482-1611
Practice Address - Street 1:210 N BROAD ST
Practice Address - Street 2:EDENTON UROLOGY CLINIC
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932
Practice Address - Country:US
Practice Address - Phone:252-482-1606
Practice Address - Fax:252-482-1611
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9900331208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1192KOtherBCBS
NC891192KMedicaid
NC891192KMedicaid
NC2270410Medicare ID - Type Unspecified