Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD016274 | TN |
NPI | 1003815580 |
---|---|
Provider Name | Dr. Thomas M Reynolds |
First Address | Chattanooga, TN 37415-6957 |
Second Address | Chattanooga, TN 37415-6957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 19/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1187690001 | DMERC GROUP SUPPLIER NUMB (01) | SC |
180029644 | RR MEDICARE (01) | |
3031931 | (05) | TN |
3069497 | BLUE CROSS (01) | |
3711088 | (05) | TN |
62-1701871 | TAX ID (01) | |
A99560 | (02) | TN |