Individual
DR. BRANDEN R. REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
62 W 7TH AVE STE 110, SPOKANE, WA 99204-2321
(509) 456-0262
(509) 462-5059
Mailing address
62 W 7TH AVE STE 110, SPOKANE, WA 99204-2321
(509) 456-0262
(509) 462-5059
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
M-8942
ID
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD00032781
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11106891
MEDICARE PTAN
ID
05
—
805509000
—
ID
05
—
8195828
—
WA
01
—
G8871050
MEDICARE PTAN
WA
01
—
G8878301
MEDICARE PTAN
WA
Enumeration date
07/13/2005
Last updated
06/18/2021
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