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General NPI Number Information
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NPI Number | 1174706006
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Entity Type | Individual
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Provider Name | CRAIG ANTHONY REYNOLDS M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 3280 WADSWORTH BLVD SUITE 100
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-4628
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Country | US
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Telephone | 303-985-3303
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Fax | 303-232-8585
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Provider Business Mailing Address
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Address Line | 3280 WADSWORTH BLVD SUITE 100
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-4628
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Country | US
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Telephone | 303-985-3303
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Fax | 303-232-8585
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 25116
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License Number State | CO
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