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NPI Code Detail

MEDICARE: BENJAMIN WALLACE REYNOLDS M.D.

MEDICARE: BENJAMIN WALLACE REYNOLDS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207L00000XAnesthesiology Physician62124MN

General Provider Information

NPI Number : 1215270434
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN WALLACE REYNOLDS M.D.
Provider Business Mailing Address
First Line : 13001 E 17TH PL
Second Line :
City : AURORA
State : CO
Zip : 80045-2570
Country : US
Telephone Number : 303-724-1765
Fax Number :
Provider Business Practice Location Address
First Line : 800 E 28TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3723
Country : US
Telephone Number : 865-342-8940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2013
Last Update Date : 07/21/2022

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