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NPI Code Detail

MEDICARE: DEANNA JUSTICE REYNOLDS M.D.

MEDICARE:   DEANNA JUSTICE 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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianJ4987TX

General Provider Information

NPI Number : 1700883642
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA JUSTICE REYNOLDS M.D.
Provider Business Mailing Address
First Line : 4941 CHERRY HILLS DR
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78413-2734
Country : US
Telephone Number : 361-993-9632
Fax Number :
Provider Business Practice Location Address
First Line : 1311 GENERAL CAVAZOS BLVD
Second Line : LAB - CHRISTUS SPOHN HOSPITAL KLEBERG
City : KINGSVILLE
State : TX
Zip : 78363-7129
Country : US
Telephone Number : 361-595-9743
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 04/28/2008

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