Healthcare Provider Details

I. General information

NPI: 1407810963
Provider Name (Legal Business Name): BRIAN EDWARD REYNOLDS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 AGENCY MAIN ST
HARLEM MT
59526-9455
US

IV. Provider business mailing address

669 AGENCY MAIN ST
HARLEM MT
59526-9455
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-3137
  • Fax: 406-353-3255
Mailing address:
  • Phone: 406-670-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS6572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: