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General NPI Number Information
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NPI Number | 1114459278
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Entity Type | Individual
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Provider Name | RYAN J REYNOLDS D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 2416 W 51ST ST
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City | TULSA
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State | OK
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Zip | 74107-7700
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Country | US
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Telephone | 713-816-2522
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 701743
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City | TULSA
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State | OK
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Zip | 74170-1743
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Country | US
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Telephone | 713-816-2522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 7541
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 7541
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License Number State | OK
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