Provider Demographics
NPI:1720120843
Name:REYNOLDS, JUDITH UNDERHILL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:UNDERHILL
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6938
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80934-6938
Mailing Address - Country:US
Mailing Address - Phone:719-338-7777
Mailing Address - Fax:719-634-5549
Practice Address - Street 1:2010 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5819
Practice Address - Country:US
Practice Address - Phone:719-434-2061
Practice Address - Fax:719-434-2275
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01233212Medicaid