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General NPI Number Information
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NPI Number | 1619931367
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Entity Type | Organization
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Legal Business Name | IAN JOHN REYNOLDS MD PA
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 450 MEDICAL CENTER BLVD SUITE 206
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-332-9676
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Fax | 281-338-7723
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Provider Business Mailing Address
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Address Line | 450 MEDICAL CENTER BLVD SUITE 206
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-332-9676
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Fax | 281-338-7723
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DIANE I GODFREY
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Credential |
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Telephone | 281-332-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MDF8994
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License Number State | TX
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