Healthcare Provider Details

I. General information

NPI: 1801894365
Provider Name (Legal Business Name): DAVID GLENN REYNOLDS SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E TAYLOR ST SUITE 103
SHERMAN TX
75090-2881
US

IV. Provider business mailing address

600 E TAYLOR ST SUITE 103
SHERMAN TX
75090-2881
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-7170
  • Fax: 903-893-4372
Mailing address:
  • Phone: 903-893-7170
  • Fax: 903-893-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH6541
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberH6541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: