Individual
CHARLES M REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-2121
Mailing address
2100 POWELL ST, STE 900, EMERYVILLE, CA 94608-1844
(510) 851-7423
(510) 879-9120
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
148073
CA
207P00000X
Emergency Medicine Physician
50485
CO
207P00000X
Emergency Medicine Physician
M-12317
ID
207P00000X
Emergency Medicine Physician
Primary
MD178898
OR
207P00000X
Emergency Medicine Physician
MD2012-0479
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022498
KAISER COMMERCIAL NUMBER
CO
05
—
22057242
—
CO
Enumeration date
05/22/2008
Last updated
07/21/2022
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