Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G18657 | CA |
NPI | 1194797357 |
---|---|
Provider Name | James B Reynolds |
First Address | Daly City, CA 94015-2630 |
Second Address | Daly City, CA 94015-2630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A40387 | (02) | CA |
GR0041210 | (05) | CA |