MEDICARE: JOHN M 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
1	207RP1001X	Pulmonary Disease Physician	01054373A	IN
2	207RP1001X	Pulmonary Disease Physician	2012-01517	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407858343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M REYNOLDS M.D.

Provider Business Mailing Address
First Line	:	5213 S ALSTON AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-4430
Country	:	US
Telephone Number	:	919-684-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 DUKE MEDICINE CIR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-4000
Country	:	US
Telephone Number	:	919-684-8111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/30/2012

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