MEDICARE: DR. MARILYN MARIE REYNAUD 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	207V00000X	Obstetrics & Gynecology Physician	MD 05293R	LA

General Provider Information

NPI Number	:	1679615702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN MARIE REYNAUD M.D.

Provider Business Mailing Address
First Line	:	7173A FLORIDA BOULEVARD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4549
Country	:	US
Telephone Number	:	225-925-3842
Fax Number	:	225-925-7245

Provider Business Practice Location Address
First Line	:	7173A FLORIDA BOULEVARD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4549
Country	:	US
Telephone Number	:	225-925-3842
Fax Number	:	225-925-7245

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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