Healthcare Provider Details

I. General information

NPI: 1881655504
Provider Name (Legal Business Name): JAMES MILTON REYNOLDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 US ROUTE 60 E
HUNTINGTON WV
25705-2022
US

IV. Provider business mailing address

PO BOX 910
HUNTINGTON WV
25712-0910
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1550
  • Fax: 304-522-0704
Mailing address:
  • Phone: 304-522-1550
  • Fax: 304-522-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number41331
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number22747
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22747
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number41331
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.089968
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: