Basic Information
| Provider Information | |||||||||
| NPI: | 1376604140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRUCE N. REYNOLDS, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 BEALL LANE | ||||||||
| Address2: | |||||||||
| City: | CENTRAL POINT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975021572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416645151 | ||||||||
| FaxNumber: | 5416645155 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 MAPLE STREET | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975201552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416645151 | ||||||||
| FaxNumber: | 5416645155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | REYNOLDS | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 5416645151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | MD19568 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.