Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 58.006033 | OH |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | OS16444 | FL |
NPI | 1245624683 |
---|---|
Provider Name | Stephen Reynolds |
First Address | Ocala, FL 34471-7765 |
Second Address | Ocala, FL 34471-7765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 19/08/2020 |