Healthcare Provider Details

I. General information

NPI: 1497985923
Provider Name (Legal Business Name): CARRIE ANNE REYNOLDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL # SE09
MADERA CA
93636-8761
US

IV. Provider business mailing address

3445 S CLERMONT ST
DENVER CO
80222-7224
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5745
  • Fax: 559-353-6093
Mailing address:
  • Phone: 303-790-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301094824
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberEMC0005381
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number55430
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA159796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: