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General NPI Number Information
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NPI Number | 1649475146
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Entity Type | Organization
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Legal Business Name | JOHN S. REYNARD, JR., M.D., INC.
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 31862 COAST HWY STE 203
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6769
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Country | US
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Telephone | 949-499-4538
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Fax | 951-674-0918
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Provider Business Mailing Address
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Address Line | 31862 COAST HWY STE 203
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6769
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Country | US
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Telephone | 949-499-4538
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Fax | 951-674-0918
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Authorized Official
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Title or Position | PRES
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Name | JOHN S. REYNARD JR.
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Credential | M.D.
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Telephone | 949-499-4538
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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 | G12598
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License Number State | CA
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