Healthcare Provider Details

I. General information

NPI: 1962437046
Provider Name (Legal Business Name): DAVID S REYNOLDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 S KING RD
PURVIS MS
39475-3208
US

IV. Provider business mailing address

1014 S KING RD
PURVIS MS
39475-3208
US

V. Phone/Fax

Practice location:
  • Phone: 601-264-2523
  • Fax:
Mailing address:
  • Phone: 601-264-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12045
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: