Healthcare Provider Details

I. General information

NPI: 1386941268
Provider Name (Legal Business Name): ROSS A REYNOLDS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY STE 480
LONE TREE CO
80124-5537
US

IV. Provider business mailing address

PO BOX 172263
DENVER CO
80217-2263
US

V. Phone/Fax

Practice location:
  • Phone: 720-441-4021
  • Fax: 720-360-1195
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07199
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number198994
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005014
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: