Healthcare Provider Details

I. General information

NPI: 1114459278
Provider Name (Legal Business Name): RYAN J REYNOLDS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 W 51ST ST
TULSA OK
74107-7700
US

IV. Provider business mailing address

PO BOX 701743
TULSA OK
74170-1743
US

V. Phone/Fax

Practice location:
  • Phone: 713-816-2522
  • Fax: 918-298-1088
Mailing address:
  • Phone: 713-816-2522
  • Fax: 918-298-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7541
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number7541
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: