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Individual
ROGER WAYNE REYNOLDS SR.
Active
Individual
ROGER WAYNE REYNOLDS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NEMT PROVIDER
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T62326452
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T62326452
DRIVERS LICENSE
VA
Enumeration date
05/06/2020
Last updated
05/06/2020
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