Healthcare Provider Details

I. General information

NPI: 1316099153
Provider Name (Legal Business Name): RICKEY J REYNOLDS MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 STANTON L YOUNG BLVD STE 209
OKLAHOMA CITY OK
73104-5021
US

IV. Provider business mailing address

711 STANTON L YOUNG BLVD STE 209
OKLAHOMA CITY OK
73104-5021
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4113
  • Fax: 405-271-5723
Mailing address:
  • Phone: 405-271-4113
  • Fax: 405-271-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number47762
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19983
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberJ4474
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: