Healthcare Provider Details

I. General information

NPI: 1972589174
Provider Name (Legal Business Name): PAUL D REYNEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 DIAGONAL RD
WORTHINGTON MN
56187-1008
US

IV. Provider business mailing address

1680 DIAGONAL RD
WORTHINGTON MN
56187-1008
US

V. Phone/Fax

Practice location:
  • Phone: 507-372-3800
  • Fax: 507-372-3706
Mailing address:
  • Phone: 507-372-3800
  • Fax: 507-372-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35809
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: