Provider Demographics
NPI:1023091543
Name:MCREYNOLDS, GEORGE WALTER (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:WALTER
Last Name:MCREYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G. WALTER
Other - Middle Name:
Other - Last Name:MCREYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14140 SOUTHWEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3842
Mailing Address - Country:US
Mailing Address - Phone:281-649-7000
Mailing Address - Fax:713-484-6649
Practice Address - Street 1:7789 SOUTHWEST FWY
Practice Address - Street 2:#470
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1829
Practice Address - Country:US
Practice Address - Phone:281-649-7000
Practice Address - Fax:713-995-4720
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6098207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB166198OtherMEDICARE - GROUP
TX038482801Medicaid
TXD66956Medicare UPIN