Provider Demographics
NPI:1669567186
Name:REYNOLDS, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2028 WOODSORREL DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1125
Mailing Address - Country:US
Mailing Address - Phone:205-988-3222
Mailing Address - Fax:205-988-3222
Practice Address - Street 1:1600 20TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4998
Practice Address - Country:US
Practice Address - Phone:205-212-5644
Practice Address - Fax:205-212-5644
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL6522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045253Medicaid
ALC76831Medicare UPIN