Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 106796 | MN |
Y | 111NI0900X | Internist | 106796 | MN |
NPI | 1003135328 |
---|---|
Provider Name | Jonathan Avery Reynolds |
First Address | Edina, MN 55435-2104 |
Second Address | Edina, MN 55435-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2010 |
Last Update Date | 21/01/2014 |