Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 51127 | CO |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | E-7585 | AR |
NPI | 1013118025 |
---|---|
Provider Name | Dr. Kirk Allen Reynolds |
First Address | Little Rock, AR 72204-1720 |
Second Address | Little Rock, AR 72204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 06/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
199625001 | (05) | AR |
297853YQCR | MEDICARE PTAN (01) | AR |
E7585 | AR LICENSE (01) | AR |