1922214220 NPI number — DR. JEROLD EVERETT REYNOLDS PHD,RCP,RRT

Table of content: DR. JEROLD EVERETT REYNOLDS PHD,RCP,RRT (NPI 1922214220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922214220 NPI number — DR. JEROLD EVERETT REYNOLDS PHD,RCP,RRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
JEROLD
Provider Middle Name:
EVERETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD,RCP,RRT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922214220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
448 FULLERS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICKERINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43147-7821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-974-6620
Provider Business Mailing Address Fax Number:
614-292-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 MCCAMPBELL HALL
Provider Second Line Business Practice Location Address:
1581 DODD DR
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-247-7122
Provider Business Practice Location Address Fax Number:
614-292-4441
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2279P1004X , with the licence number:  2850 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com