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NPI Code Detail

MEDICARE: MR. JEREMY REYNOLDS PA-C

MEDICARE: MR. JEREMY REYNOLDS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA06282TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518933852
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEREMY REYNOLDS PA-C
Provider Business Mailing Address
First Line : 322 COLEMAN ST
Second Line : PO BOX 60
City : MARLIN
State : TX
Zip : 76661-2358
Country : US
Telephone Number : 254-803-3561
Fax Number : 254-883-6066
Provider Business Practice Location Address
First Line : 322 COLEMAN ST
Second Line : FALLS COMMUNITY HOSPITAL
City : MARLIN
State : TX
Zip : 76661-2358
Country : US
Telephone Number : 254-803-3561
Fax Number : 254-883-6066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 01/11/2010

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