Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BP10034611 | TX |
N | 111NI0900X | Internist | BP10034611 | TX |
Y | 207RX0202X | Medical Oncology | Q2610 | TX |
NPI | 1164656435 |
---|---|
Provider Name | Dr. Jana Marie Reynolds |
First Address | Dallas, TX 75391-1230 |
Second Address | Dallas, TX 75246-2012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 03/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
347260701 | (05) | TX |
347260702 | (05) | TX |
P01819921 | RAILDROAD (01) | TX |