MEDICARE: DR. F DOUGLAS REYNOLDS D.P.M.

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	213E00000X	Podiatrist	POD 181	ME
2	213ER0200X	Radiology Podiatrist	POD 181	ME
3	213ES0000X	Sports Medicine Podiatrist	POD 181	ME
4	213ES0103X	Foot & Ankle Surgery Podiatrist	POD 181	ME

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	:	1962483719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. F DOUGLAS REYNOLDS D.P.M.

Provider Business Mailing Address
First Line	:	739 WESTERN AVE
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1036
Country	:	US
Telephone Number	:	207-944-8152
Fax Number	:	207-862-6742

Provider Business Practice Location Address
First Line	:	739 WESTERN AVE
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1036
Country	:	US
Telephone Number	:	207-947-2220
Fax Number	:	207-947-4073

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/15/2021

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