Basic Information
Provider Information
NPI: 1235659087
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REYNOLDS
FirstName: DANIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 HOSPITAL RD
Address2: CALLER BOX C-268
City: CHEROKEE
State: NC
PostalCode: 28719
CountryCode: US
TelephoneNumber: 8284979163
FaxNumber:  
Practice Location
Address1: 1 HOSPITAL RD
Address2: CALLER BOX C-268
City: CHEROKEE
State: NC
PostalCode: 287192871
CountryCode: US
TelephoneNumber: 8284979163
FaxNumber: 6057554012
Other Information
ProviderEnumerationDate: 06/22/2017
LastUpdateDate: 09/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/26/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207Q00000X02533NCY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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