Individual
TIMOTHY J REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
508 MEDICAL CENTER BLVD, STE 200, CONROE, TX 77304-2808
(936) 760-4600
(936) 760-4601
Mailing address
508 MEDICAL CENTER BLVD, STE 200, CONROE, TX 77304-2808
(936) 760-4600
(936) 760-4601
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
K9159
TX
207RC0000X
Cardiovascular Disease Physician
K9159
TX
207RI0011X
Interventional Cardiology Physician
Primary
K9159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J21A
MEDICARE GROUP NUMBER
TX
01
—
094010801
MEDICAID GROUP NUMBER
TX
05
—
164601003
—
TX
Enumeration date
08/11/2006
Last updated
11/15/2012
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