Provider Demographics
NPI:1649475146
Name:JOHN S. REYNARD, JR., M.D., INC.
Entity type:Organization
Organization Name:JOHN S. REYNARD, JR., M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:REYNARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:949-499-4538
Mailing Address - Street 1:31862 COAST HWY
Mailing Address - Street 2:STE 203
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6769
Mailing Address - Country:US
Mailing Address - Phone:949-499-4538
Mailing Address - Fax:951-674-0918
Practice Address - Street 1:31862 COAST HWY
Practice Address - Street 2:STE 203
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6769
Practice Address - Country:US
Practice Address - Phone:949-499-4538
Practice Address - Fax:951-674-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty