Individual
DR. JACKSON DAVID REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 N 12TH ST STE 508, PHOENIX, AZ 85006-2849
(602) 839-3927
(602) 839-4233
Mailing address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
72531
AZ
208000000X
Pediatrics Physician
72531
AZ
208D00000X
General Practice Physician
Primary
72531
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2021
Last updated
03/18/2024
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