Individual
MR. JOEL WAYNE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
61 CHARLES ST, DEADWOOD, SD 57732-1303
(605) 722-6101
(605) 719-6133
Mailing address
353 FAIRMONT BLVD, ATTEN MSS, RAPID CITY, SD 57701-7375
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0548
SD
Other
Enumeration date
06/28/2006
Last updated
01/23/2013
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