Basic Information
| Provider Information | |||||||||
| NPI: | 1568642353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W THOMAS RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024064000 | ||||||||
| FaxNumber: | 6024066498 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W THOMAS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024065483 | ||||||||
| FaxNumber: | 6024065488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 04/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A100903 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 42634 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 42634 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RT0003X | 42634 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
No ID Information.