Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301088730 | MI |
N | 207X00000X | Orthopaedic Surgeon | A50293 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME123787 | FL |
N | 207XS0117X | Orthopaedic Spine Surgeon | A50293 | CA |
NPI | 1598701930 |
---|---|
Provider Name | Dr. Richard Albert Keith Reynolds |
First Address | Rockland, DE 19732-0191 |
Second Address | Pensacola, FL 32504-8785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 28/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
'014781200 | (05) | FL |
20-0-82-6207-1 | BCBSM (01) | MI |
4919117 | (05) | MI |
F18622 | (02) | MI |