Healthcare Provider Details

I. General information

NPI: 1922214220
Provider Name (Legal Business Name): JEROLD EVERETT REYNOLDS PHD,RCP,RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MCCAMPBELL HALL 1581 DODD DR
COLUMBUS OH
43210-1205
US

IV. Provider business mailing address

448 FULLERS CIR
PICKERINGTON OH
43147-7821
US

V. Phone/Fax

Practice location:
  • Phone: 614-247-7122
  • Fax: 614-292-4441
Mailing address:
  • Phone: 740-974-6620
  • Fax: 614-292-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number2850
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: