Provider Demographics
NPI:1255442778
Name:REYNOLDS, FRANK S (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:S
Last Name:REYNOLDS
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44261207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G442610Medicaid
CA3863OtherFIRST HEALTH
CA41629OtherINTERPLAN
CA014073OtherHEALTH NET
CA0131110OtherCIGNA
CA1028147OtherUNITED HEALTHCARE
CA4394186OtherAETNA
CAG44261OtherBLUE CROSS
CAMCMG306600OtherWESTERN HEALTH ADVANTAGE
CA90030020OtherPACIFICARE
CA14294OtherGREAT WEST
CA90030020OtherPACIFICARE