Provider Demographics
NPI:1831485267
Name:ROBERT REYNOLDS MD PC
Entity type:Organization
Organization Name:ROBERT REYNOLDS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-752-0871
Mailing Address - Street 1:11100 HEFNER POINTE DR STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5049
Mailing Address - Country:US
Mailing Address - Phone:405-752-0871
Mailing Address - Fax:405-755-9510
Practice Address - Street 1:11100 HEFNER POINTE DR STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5049
Practice Address - Country:US
Practice Address - Phone:405-752-0871
Practice Address - Fax:405-755-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332900000X
OK20272207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100091560AMedicaid
OK100091560AMedicaid
OK440840981Medicare PIN