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General NPI Number Information
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NPI Number | 1134563653
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Entity Type | Individual
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Provider Name | CHRISTOPHER STEPHEN REYNOLDS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 240 WILLOW ST
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City | TYLER
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State | MN
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Zip | 56178-1201
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Country | US
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Telephone | 507-247-5591
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Fax |
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Provider Business Mailing Address
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Address Line | 240 WILLOW ST
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City | TYLER
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State | MN
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Zip | 56178-1201
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Country | US
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Telephone | 507-247-5591
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26526
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 68049
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License Number State | MN
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