Basic Information
| Provider Information | |||||||||
| NPI: | 1982869251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11750 W 2ND PL | ||||||||
| Address2: | STE 255 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203218040 | ||||||||
| FaxNumber: | 7203218041 | ||||||||
| Practice Location | |||||||||
| Address1: | 11750 W 2ND PL | ||||||||
| Address2: | STE 255 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203218040 | ||||||||
| FaxNumber: | 7203218041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 48940 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.