Individual
DR. THOMAS M REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2158 NORTHGATE PARK LN, SUITE 302, CHATTANOOGA, TN 37415-6957
(423) 870-4900
(423) 870-5889
Mailing address
2158 NORTHGATE PARK LN, SUITE 302, CHATTANOOGA, TN 37415-6957
(423) 870-4900
(423) 870-5889
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD016274
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1187690001
DMERC GROUP SUPPLIER NUMB
SC
01
—
180029644
RR MEDICARE
—
05
—
3031931
—
TN
01
—
3069497
BLUE CROSS
—
05
—
3711088
—
TN
01
—
62-1701871
TAX ID
—
Enumeration date
07/18/2005
Last updated
06/19/2008
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