Individual
DR. TYLER SHANE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3800 S NATIONAL AVE STE 600, SPRINGFIELD, MO 65807-5249
(417) 875-3000
Mailing address
215 KATNACK RD, ST AUGUSTINE, FL 32095-8352
(678) 737-1024
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
074569
GA
208600000X
Surgery Physician
2022007281
MO
208600000X
Surgery Physician
A101986
CA
2086S0102X
Surgical Critical Care Physician
Primary
ME163370
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200116135
—
MO
Enumeration date
08/28/2007
Last updated
04/28/2026
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