Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POD 181 | ME |
N | 222Z00000X | Podiatrist | POD 181 | ME |
N | 111NR0200X | Radiology | POD 181 | ME |
N | 213ER0200X | Radiology | POD 181 | ME |
N | 2081S0010X | Sports Medicine | POD 181 | ME |
N | 213ES0000X | Sports Medicine | POD 181 | ME |
Y | 213ES0103X | Foot & Ankle Surgery | POD 181 | ME |
NPI | 1962483719 |
---|---|
Provider Name | Dr. F Douglas Reynolds |
First Address | Hampden, ME 04444-1036 |
Second Address | Hampden, ME 04444-1036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126420099 | (05) | ME |
T31296 | (02) | ME |