MEDICARE: LANCE REYNOSO MD

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
1	207Q00000X	Family Medicine Physician	36457	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1902883531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE REYNOSO MD

Provider Business Mailing Address
First Line	:	PO BOX 62
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81502-0062
Country	:	US
Telephone Number	:	970-298-2894
Fax Number	:	970-298-1809

Provider Business Practice Location Address
First Line	:	2698 PATTERSON RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8818
Country	:	US
Telephone Number	:	970-298-2800
Fax Number	:	970-298-6291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	01/20/2014

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Directions to “ LANCE REYNOSO MD” Practice Location

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