Basic Information
| Provider Information | |||||||||
| NPI: | 1760494900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 SW 10TH AVE | ||||||||
| Address2: | MEDICAL STAFF SERVICES | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546241 | ||||||||
| FaxNumber: | 7852704343 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W 22ND ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053121000 | ||||||||
| FaxNumber: | 6053121001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 05-30785 | KS | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 8781 | SD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 200264700A | 05 | KS | MEDICAID | KA2129013 | 01 | KS | MEDICARE PTAN | OTHER |