MEDICARE: DR. STUART REYNOLDS MD

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	390200000X	Student in an Organized Health Care Education/Training Program		OK
2	208600000X	Surgery Physician	W2350	TX

General Provider Information

NPI Number	:	1427554898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART REYNOLDS MD

Provider Business Mailing Address
First Line	:	1802 E 19TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-5403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 E 19TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-5403
Country	:	US
Telephone Number	:	918-634-7539
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	01/13/2026

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