Provider Demographics
NPI:1750437083
Name:MCREYNOLDS, JEFFREY R (CNMT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:MCREYNOLDS
Suffix:
Gender:M
Credentials:CNMT
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:708 E SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 QUARTER ST
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1959
Practice Address - Country:US
Practice Address - Phone:989-246-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI0255192471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology